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Wisconsin Department of Commerce
Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count
INSPECTION REPORTt. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No -:
Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. 363983
Permit Holders Name: ❑ City []Village ❑ wn of: State Plan ID No.:
B ri ggs, Willia Somerset Township
CST BM Elev.:- Insp. BM Elev.: BNJ Description: Parcel Tax No.:
1 S � 5 032- 1003 -10 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic tie k: �UD Benchmark Z y )
Alt. BM
Aera I n Bldg. Sewer
Holding Z/ Ht Inlet ru f
TANK SETBACK INFORMATION / Ht Outlet �6, 2—
TANK TO P/ L WELL BLDG. Ventto ROAD e
Air Intake
Septic j + 7SLl' 3 b I NA
D n NA Header / Man.
Aeratio NA Dist. Pipe Q z
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade x �'_ Z 6,
cturer Demand St cover 3 �
Model Number
TDH Li Friction stem TDH Ft
Loss e
For emain Length Dia. Dist.To
SOIL ABSORPTION SYSTEM ,
BED / EN Width Length No. Of Trench t, r D,MENS, ON S PIT No. Of Pits Inside Dia. Liquid Depth
DIME P Z
SETBACK
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEAC I Manu aIurer:
INFORMATION System: L� J �( - t b ✓ 7 S d r:
IT r
DISTRIBUTION SYSTEM
Header / Mani / old r Distribution Pipe(s) / x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. �� Spacing M j Z
—Yf– 1 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over FDepth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed / Trench Center Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
Inspection #1: T / 3 /L1 O nspection
Location: 689 Polk St. Croix Road, New Richmon , WI 54017 (NE 1/4 NE 1/4 2 T3 IN R1 9W) - 02311917A -Lot 3
1. Alt BM Description= 5 s�cr,
2.) Bldg sewer length= I y
_i%rue! lj�:.•� f S�i�� �o�5�setl.�.� e•� `�ir G��ict� tar�5
- amount of cover
Plan revision required? ❑ Yes No
Use other side for additional Inforalatlon. V y , b, I 4
`r SBD -6710 (R.3/97) Date ' nspector's Sig ture Cert. No.
l�
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
1
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Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave.
10sconaln See reverse side for instructions for completing this application 15 Box 7302
Personal information you provide may be used for secondary purposes Madison, WI 53707.7302
00ptirtment of Ce rm"ree [Privacy Law, s. 4 5.04(1)(tn)] (Submit completed form to county if not
state owned
Attach complete plans to the county copy on for the system, on paper not less than 8 - 1/2 X. I I inches in size.
CoumY �t S s�n t Number 1 Check if revision to previous application State Plan I. D. Number
l:rD�k b
I. Application Information - Please print all Information Loeationt
Property Owner Name Property Location
�/4 /4,S 2 T N o W
Property Owners Mailing Address Lot Number Bl Num
p 3 .�
6 ✓ a x cl
City, State Zip Code phone Number Subdivision Name or CSM Number
Ke, ��z% I S �'l6 �7 dU/ /D
II. Type of Building: (check one) 13 City
[ or 2 Family Dwelling - No. of Bedrooms: C3 Village
#own of
13 Public /Commercial (describe use):_
❑ State -Owned
Nearest Ro / G'o�X /CKY
Parcel ax Number(s) 003. 0 -u/u
III. T vve of Permit: Check only one box on line A. Check box on line B if applicable
A) 1. New 2. W Replacement 3. 13 Replacement of 4. 5. 6. Addition to
system Sy stem Tank Only Existing System
C3 B) Permit Number Date Issued
A Sanity Permit was issued
IV. Type of POWT System: (Check all that apply)
-Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V. Dispersal/Treatment Area Information:
I. Desrgn Flow (ad) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate System slevation 7. Final Grade
Required Proposed Rate Gals. /day /sq. ft.) (Min. /inch) �,a , Y Elevation
s� 37.s (015/' z — a a
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con - Con- glass
New Existing crete strueted
Tanks Tanks
S ❑
G �Q 66 � OG o Gi�a
❑ ❑ ❑ ❑ ❑
VIII. Responsibility Statement
I the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumbers Name (print) Plum s store (no stamps): MP RS No. Business Phone Number
Plumber's Address (Strut, City, State, Zi
/ :5 7
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps)
Approved C3 Owner Given Initial Adverse Sur ge Fee)
Determination r S ^3-
X. Conditions of Approval /Reasons for Diisappr l: _
On b�A eQ. ao 2- .
e , ` c06
3 7S-R-"'
PLOT PLAN
PROJECT William Brioas ADDRESS 689 Polk/St. Croix Rd New Richmond Wi 54017
NE 1/4 NE 1/4S 2 /PDPRESSU SSURE N/R 19 W TOWN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 7/26/00 BEDROOM 3
CONVENTIONAL )00( IN -G O CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000/800 LIFT TANK SIZE DOSE TANK SIZE
001, DING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22
A k NCHMARK V. .P. Base Of StUCCO ASSUME ELEVATION 100' F il abel A -100
BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 86.8/84.8
Alt. BM Base of Bird Feeder @ 95.4'
Polk/St.Croix Rd
Vent
ALong 6 "
Sidewinder High
Capacity Leaching
Chamber
34" Grade at System Elevation
25'
Well
8'
Existing 3
Bedroom 30'
2 -3' X 69' Trenches House
with >3' Spacing B.M. 15' ?
Vents Al c
30'
20' 35'
5'
B-2
LOld - -`- 30' ST rywell is to be
18% T 0 ' ed and buried
a Slope 0 ,
Vents B -1 40 DW
c0
,� Overflow
Wisconein Deportment of Comerce SOIL EVALU REPORT
Division of Safety end Buildings
in accordance with Comm 85, Wis. Adm. Code
Attach compkt Nk
a Plan on paper not less than S 112 x 17 inches in size. Plan must County 1,
InclWa, but not thrilled to: vertiml and horizontal reference point (BM), direction and Parcel I.D. ?� r � b
Psroent slope. sank or dimensions, north arrow, and loostion and distance to nearest road. J J� Old U
Please print all Information. "&wed by Date
pewroal Inkmatien you provide nxy be wed for seeo^dwY Ouse tPomaY Law. a. 15.04 (1) (m)).
rty Owne / r mm arty Location
w Govt Lot 1l4 /� 1/4 S O2_ T 3 N R E( W
Properly Owner's Melling Address Lot # Block # Subd. Name or CSM#
QW State p Code Phone Number O City El village ;15-X Newest Road
- New ConstruWon w den ttel Number of bedrooms = Code derived design flow rate GPD
eplaoe►r►ent ❑ Public or rcia! - Describe:
Parent material Rood Plain elevation if applicable _ _ /✓ I X!- ft. t3eneral comments
end reoomtnerMatim"
Boring # ❑ goring ZS
pit Ground surface elev. ft. Depth to limiting factor _,ze ( In.
SON Horizon Depth Dominant Color Redooc f
Descriptio Textwe $bvchtre Conslatenoe Boundary Roots f3PDlfl°
im Munw Qu. Sx. Cont. Color Gr. Sz. Sh. "EfMit •Etf#r2
p" D �3 /Z
6"
E ' � d J
a Bori ng #�.
Pit Ground surface ekv. ' it. Depth to Ihttiting fschx ,� In,
k
Horizon Depth Dominant cow Redox Description Textwe Structure Cormwencs Boundary Roots Rpw
In. Munsell Qu. Sz. Cont. Color Or. Sz. Sh. Tom "
O' /Z �-z S' nom- ✓' � ,� - . 5"
3 -3 6r s s�
ti
Lf limt #1 a 9GD s 30 1220 mq& and TSS :30 =150 not • EMMA 02 = BOD < 3D mg/, and T86 a 30 digit.
CST Nsme (Please PRIM) r T Nwnbpr
_ 44E _ J
�U U
Address ate
�7M Tel ephone uneber
Property Owner __ / Parcel ID # Page - -of
Boring # ❑ Boring b ng
Plt Ground surface eiev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Cola' Redox Description Texture Structure Consistence Boundary Roots GPD/ff
In. / Munsell Qu. Sz. Cont Color Gr, Sz. Sh, 'Eff#1 `EfT#2
c ti.— -
S - S
a Boring # ° Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor 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. 'E `f
❑ Boring # ❑ Boring
❑ Pit Ground surface elev. __� _ ft Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD
In. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. 'Eff#1 'Eff#2
'Effluent #1 = SOD > 30 220 mg/L and TSS >30 <_ 150 mg/L ' Effluent #2 - BOD < 30 mg& and TSS 5 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.
SOD -53W (KAMO)
William Br Soil Test Plot Plan
Project Name ggs Shaun
Address 689 Polk/St. Croix Rd �/�
New Richmond Wi 54017 C #226900
Lot 3 Subdivision --- ---- Date 7/26/00
NE 1/4 NE 1/4S 2 T 31 N /R W Township Somerset
F'] Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Base of Stucco Siding
System Elevation 86.8/84.8 *HRP Same as Benchmark
Alt. BM Base of Bird Feeder @ 95.4'
Polk/SLCroix Rd
25'
• Well
8'
Existing 3
Bedroom 30'
se
93.0' B.M 15'
91.0 5'
9. 0'
IF 5'
2 5' 35'
B -2 ST
a� 18%
0'
a Slope
40 D W
� B -1
,� Overflow
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I have inspected the septic tank presently
serving the 3-; g ,,< residence located at:
&15: _ ; , / ; , Section T 3) N, R W, Town of
_,�n ✓ S2Z Upon inspection, I certify that I have found
the tank and baffles to be in good condition, and it appears to be
functioning properly.
Last time serviced: /.s WA-21900
Did flow back occur from absorption system?
Yes X No (If no, skip next line)
Approximate volume or length of time: gallons minutes
Capacity:
Construction: Prefab Concrete Steel Other
Manufacturer: (If known)
Age of Tank (If known).: 2 pV'-'a-/L<
nature) (Name) Please print
'(Title) (License Number)
—� �- a
Date
Form to be completed by licensed plumber (s.145.06, Wisconsin
Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative
Code)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank
condition, I certify that the tank to the best of my knowledge will
conform to the requirements of ILHR 83, Wi . Adm. Code (except for
inspection opening overt outlet baffle).
Name S ignat ^ MP /MPRS �(�
r
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer �o�� r �; % 0 r ; Q a A&
Mailing Address b �� �� rk -�• C f,� i /P�2,� r.�+�� -�..�� L� r s `jS t �7
Property Address s -ems
(Verification required from Planning Department for new construction)
�
City /State Parcel Identification Number
LE GAL DESCRIPTION
Property Location AZ 11 /4, AIE V4, Sec. 9 , T 3 I N -R W, Town of 50ort
Subdivision , Lot # _.
Certified Survey Map # �/� °�9_ Volume /Lo _, Page # 1 ;? 7d
Warranty Deed # 2 X .5 aS , Volume yZ S , Page # 3 6 y
Spec house ❑ y-- Lot lines identifiable yes ❑ 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
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 Zoning Office within 30
days of the three year expiration date.
SIGNATURE OF APPLICANT 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 owner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE OF APPLICANT DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.******
** Include with this application: cation: a stamped warranty deed from the Re gister of Deeds office
P
P P h' $
a copy of the certified survey map if reference is made in the warranty deed
Jl ,
N". tti: +� � t hoed ( n b'1'.1i C� I �'IJ('IINSI V) Puhll�hed by Eeu Clnlro Book 6 BtatlanRy Co.
I
Iurm \n. _
(�t���i ,�IIL�f Iit1I1 C, Made this r. 3 clay of July A. D., 19
LI' between Ir1 : -z: �' .'r;t ^i r .;P£'. l n .
a Corporation duly organized and existing under and by virtue of the laws of the State of Wisconsin,
located at 0 lC r Wisconsin, party of the first part, and
i
i
part e, of the second part.
UltttlfO$rtb: That the said party of the first part, for and in consideration of the sum of
car :r - t;or
to it paid by the said part ; of the secont_7 part, the receipt whereof is hereby confessed and acknowl-
cotlped, has !riven, s ;ranted, bargainod, sold, remised• released, aliened, conveyed and confirm,-,l, -,nd by
these prese:rts floes ,:tivo. r,-rnt, bar --rein, soil, remise, rolc, -, alien, convey and confirm nnro th_` said
part t, of the .seconrl part, t i. heirs and nssil forever, the following described real estate,
situate ;l in fl— County of and State of Wisconsin, to -wit:
I I FII�t
h l�
I II � _ r ; � V � I _` _�� -•' ��I
thereunto belonging or in an ;�ivise
I f j7 t. ; i,lirrt r,r :I, r l_tna wlunsocver, of the said party of the
;Lnr t -i•h n n, ol t`< ;ni -v, -ithc`r in possession or etprctanry t,;, in nrvl to the above hug.dncd
t t i',,i!�A i .iii .�t ; 1 ;711. ., s.i� . ,;r ; , , r 'i ,1 rc irh 'hr• _„ iii t: t.�., ;ti. .. _I t,l, rrirr.�. ,�. „ .
r 11._ r"1
_.t,rs, do r_ ,. .rant, ha. - grim and :r,t;ree to wl ;r ,k.lh ':te
r
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Cl:nntersigned: L{ �' r
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VJ:.- i h. -•`� t1,._
. .. ❑.... id,q Ih:,t ell in•_t:un:ente to he re-orded shall have plainly printed or typ— ritten thereon the oars'', �� the gran"., rte.
K:antei �. Hitne -•e� an.l o,rt:lr—
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516994
CERTIFIED SURVEY MAP
Located in part of the Northeast Quarter of the Northeast Quarter of Section 2,
Township 31 North, Range 19 West, Town of Somerset, St. Croix County, Wisconsin.
Surveyed for'and at the request of: LEGEND
Brad Briggs Aluminum Monument found
689 Polk -St. Croix Road
New Richmond, WI 54017 • Found 1" Iron Pipe
William Briggs - Owner o Set 1" x 24" Iron Pipe weighing
1.68 pounds per linear foot
+�—• Fence
UNPLATTEDLANOS
N 1/4 CORNER NORTH LINE OF THE NE 1/4 NE CORNER
SECTION 2 SECTION 2
- N89 "E 2614.04 REC.AS 2613.76' - - - --\
�- - - /- - -
N89 36'22"E 994.02'
=CENTER MIA - —� \
1307.02 - -231_03' --� - _ _ _ 762.99'- - — __.J 313.00'
231.00 i 7f 3.03 4s ca a
g - - S89 59 "E 994.03 - - -'w w Om m 1
'�P
... ......... N .... .... --- —
y.t.HOUSE ,` ........................ � � �D LOT �
o 0 9LL HIGHWAY SETBACK c C. S . M . 1
PPR` LOT 2 SEPTIC o SHED rn + 1V. 61
(A -4 =BARN n p w
D ° I
N p
O !n � PG. 1633
� two 8 m
MAY'%2`�5'A! o S Ln 4'
Z LOT 3 N890 36' E A 'I
S . CR�lXCOUNTY,� ° °- 1,386,664 sq. ft. ] Total Area 313.00 8
Cor iprehensive Platliiiorc 31.833 acres ] m -b
Zoning and ;1 y 231.00' 1, 365,131 sq. ft. ] y -,
arksCornmitt8e im Iri N89°59'59 "W 31.339 acres ) Excluding R/W -1 -
r �
I° z IC
if no!'rscorded 1D
� N O M I'D _ �
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2 q' Total Area '"U' 0 im
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SOUTH LINE OF THE NE 1/4 OF THE NE 1/4 13'
N89 15 36 " W 1312.66' 6' I
Bearings are referenced
to the north line of the UNPLATTED LANDS I.
NE; assumed to bear „ , w•1
N89 0 36 1 22 "E. SCALE I = 250 �' I
PE
200 100 0 250 1
Drafted by D.J.Z. E I/4 CORNER
SECTION 2
COUNTY GENERAL NOTICE
Note: The parcel shown on this map is subject to State, County and Township
laws, rules and regulations (i.e. wetlands, minimum lot size, access to parcel,
etc. ). Before purchasing or developing any parcel, contact the St. Croix County
Zoning Office and the appropriate Town Board for advice.
Z HAY 2 199 )) J AMES O ter ECL Vol. 10 Page 2760 Sltg
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LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02
REAL ESTATE TOWN OF SOMERSET
COMPUTER NUMBER 032 - 1003 -20 -000 Parcel Number 2.31.19.17B
OWNER NAME: First WILLIAM G & MARY B Last BRIGGS
PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment
697 CTY LINE RD
SECTION 2 TOWN 31 N RANGE 19W '/,160 '/.40
Line Description Line Description
TOTAL ACREAGE 3.000 PLAT LOT BLK
01 SEC 2 T31N R19W 3 A IN NE NE 15
02 FRL BEG NE COR SEC 2 TH S 16
03 418' ALG E LN NE1 /4, TH S 17
04 89 DEG W 313', TH N 418', TH 18
05 N 89 DEG E 313' ALG N LN 19
06 NE1 /4 -POB NOW KNOWN AS 20
07 LOT 1 CSM 6/1633 21
08 22
09 23
10 24
11 25
12 26
13 27
14 28
F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit
.A, 1 ' FORM NO. 985 -A
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(� Mown «carorn®M
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2 Stock No. 26273
40S659 >q, et
_ CERTIFIED SURVEY MAP
LOCATED IN THE NE1 /4 OF THE NE1 /4 OF SECTION 2, T31N, R19W
I of °w�
SCALE IN FEET Iz 0i ` (A
I I. 66' Z) -j <
300 N CL
100 200 ' - 0 I Z i- I
CENTERLINE U N P L A T T E D L A N D S ___ aw �LO! _—
N89 °3 6'22' E 2613. EXISTING TOWN ROAD
N 89 36' 22 "E 313'
cn ��
NORTH LINE OF NE1 /4 M _ _ _ _ _ _ M _ N N 1 /4 CORNER N89 0 36'22 "E 313' u,
SECTION 2 z POINT OF BEGINNING
T31N, R 19W -� NE CORNER
SET MONUMENT �. SECTION 2
OWNER SUBDIVIDER < T31N, R19W
WILLIAM N. BRIGGS �I u. SET MONUMENT
R.R. #2, BOX 148 DI V 0 0l
NEW RICHMOND, WI. 54017 Z co LOT 1 00 wl
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LEGEND
UN PLATTED LAN D S 3 w
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ST. CROIX COUNTY SECTION CORNER MONUMENT, BERNTSEN 'f' w
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CAP, FOUND OR SET AS NOTED. o J
0 1 "x24" IRON PIPE SET WEIGHING 1.68 # /LINEAL FOOT. °
cn F-
- EXISTING FENCE.
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* AREA OF PARCEL INCLUDING TOWN ROAD RIGHT -OF -WAY.
** AREA OF PARCEL EXCLUDING TOWN ROAD RIGHT -OF -WAY.
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FI LED APPROVED •�
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COMP.ZEHFN51VE PARR PVA 4440 O O
AND ZONWG COMWTTEE u h - Z
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Drafted by Walter J. Gregory. w N LL
Vol. 6 Page 1633
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