HomeMy WebLinkAbout040-1037-20-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
4 1 INSPECTION REPORT Sanitary Permit No: 453242 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 Village X Township Parcel Tax No:
Fe ereisen, Norman I Troy Township 040 - 1037 -20 -100
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
0 (� Y-W ' 'i M E a rray) 08.28.19.123A
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer -7.8q /
Holding St/Ht Inlet 0 •3 r /
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROA Dt Inlet �-
Septic ,`� Dt Bottom �- —
Dosing Header /Man. rO �
�?Z J
Aeration Dist. Pipe a bS 1 —
l
Holding Bot. System ?'. 7 73 -
PUMP /SIPHON INFORMATION Final Grade 77, 0
Manufacturer GP and St Cover
T 7d J
Model Number
TDH Lift Friction L ss Syste Hea TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia
DIMENSIONS 3 1 s GO N /A a ,
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STRE LEACHING Manufacturer:
INFORMATION Type Of System: CHAMBER OR
yp _ / / �w0 UNIT Model Number:
Ve Al ce d v. O �
DISTRIBUTION SYSTEM
Header /Manifold IDistribution x Hole Size x Hole Spacing Vent to Air Intake
p / 4 Pipe(s)
Length / Dia 1 1-eng
SOIL COVER x Pressure Systems Onl x x Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center I �� Bed/Trench Edges 1 y Topsoil 1 Yes f` I No !Yes " No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:// In soe? /
Location: 429 Townsvalley Road Hudson, WI 54016 (NE 1/4 SE 1/4 8 T28N R1 9W) 40 acres Lot Parcel No: 08.28.19.123A
1.) Alt BM Description =
2.) Bldg sewer length =
- amqunt of cover = - 7'�
X 04y , � V1ti 4 or rl
T - -- - - -- -- - - - — -
Plan revision Required? (] Yes No
Use other side for additional informs on.
—
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Date I sepctoes Signature Cert. No.
SBD -6710 (R.3/97)
Visconsin Safety and Buildings Division County n 201 W. Washington Ave., P.O. Box 7162 T C.0 o
Madison, WI 53707 - 7162 Sanitary Permit Number (to be fili d in by Co.)
Department of Commerce (608) 266 -3151 3
Sanitary Permit Application State Plan I.D. Number J _ Q
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide / `
may be used for secondary purposes Pr' .04 I m Project Address (if different than mailing address)
I. Application Information - Please Print r ation ' �Z 9 - 7a - wn S vx� t E/
Prop�e Owner's Name MAY 2 5 2004 Parcel # Lot # /} Block #/ 14
Property Owner's Mailing Address I CROIX'i;OUN'1 Property Location
Al2q I-- W4s V l� 0 f ZONING OFFICE g� 23
1 F %, .SL: Y., Section CJ
City, State J Zip� Code
T7P,� one Number ,Q 2
�7� 6 r ! ' 386 7 T G�i N; R of W e) _B 7 ' J
II. Type of Building (check all that apply)
n _ I , t Subdivision Name CSM Number
I or 2 Family Dwelling - Number of Bedrooms si',C -J T� ��
- SPL /T
❑ Public /Commercial - Describe Use '\ /! ` .� lu
El Owned - Describe Use UI�T / 7 �� ❑Cih_ ❑Village Township of
z7 �—
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. 11 �t�+ New System �a Replacement System ❑ Trcatment/Holding Tank Replacement Only El Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS Sys tem: Check all that appl
IN No - Pressurized In- Grou ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter chin Sr ❑ Drip
inc ❑ Gravel- ess Vip ❑ Other (expl Z
V. Dispersal/Treatment Area Information YS 3 4 1 - CAAIII
Design Flow (gpd) Design Soil Application 0 te(g Dispersal Area Required (st) Dispersal Area Proposed (sf) Systc - (Elevation /
600 1 . - 1 9:5 1 0 gZ ,o f/
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank ne Z 5o it w-
Aerobic Treatment Unit �
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Signature MP/ Number Business Phone Number
— FIM 7, z (65z 715-7
Plumbe 's Address (Street, City, State, Zip Cod
31 z8 t-4 /Vvt &J d
VIII oun /De artment Use Onl
Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater D Issued sluing Agent gna a ps) `
Surcharge Fee) p G
❑ Owner Given Reason for Denial
IX Conditions of Approval/Reasons for Disapproval PQW7-T 77
STEM OWNER:
1 Septic tank, effluent filter and 4 6 p 3.
Ispersa ce mus s rviced / maintained
as went plan provided by plumber.
2• main
c comp ete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size
SBD -6398 (R. 01/03)
JOB Norm f �,erei.e✓1
TIMM EXCAVATING SHEET NO. OF
Route 1 Box 192 c _
WILSON, WISCONSIN 54027 CALCULATED BY DATE 7 2 /
(715) 772 -3214
MPRS � WI CHECKED BY DATE
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FROO=100.7�W- Orchm ANa. 01471. To Order PHONE TOLLFRM i�B00d2569B0
JOB
lVOrrsi re re /�P✓1
TIMM EXCAVATING SHEET NO. OF
Route 1 Box 192
WILSON, WISCONSIN 54027 CALCULATED BY DATE
(715) 772 -3214
MPRS ��j t WI' CHECKED BY DATE
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PRODUCT 205-1 � Inc„ Groton, Mau. 01471 , To Order PHONE TOLL FREE 1-800-225 -6380
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer D�'wl ��t e1,,,¢1t A
Mailing Address
Property Address
(Verification re uired from Planning D partment for new construction) JEX I S T Ce- 4YQ z)
City /State 6,�apy t)z Parcel Identification Number 0y0 - ) Zo -p
LEGAL DESCRIPTION
• 1
Property Location � L ' /4, 57 -*-- ' /a, Sec. 8 , T aD N -R /'I W, Town of ! �N
Subdivision ka Lot #
Certified Survey Map # /U 4 , Volume , Page #
Warranty Deed # _ 17 Volume / Page # l
Y P/h?2lirilir � —
Spec house ❑ yes K no 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.
I/we, 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 e three year ex ' tion date.
�C� J 10 ,5j V S GNATURE OF APPLI 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 y described above, by virtue of a warranty deed recorded in Register of Deeds Office.
3f G ' 54ATURE OF A.PPLICOIT 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
System Management
Management of this system is critical. As a condition of approval of these plans this system management section must be
reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems
develop with the adsorption system or any other system components, the installing plumber, Timm Excavating, 715- 772 -3214, or the St.
Croix County Zoning Office, 715- 386 -4680, should be contacted for assistance.
General
Proper functioning of an on -site disposal system, "septic system," is significantly dependent on the volume of water which flows
into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the
better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and
contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or
compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water
in a manner to protect ground water quality and public health.
I . If the septic tank is installed prior to sheet -rock and/or painting, pump the septic tank before normal use begins to ensure adherence
to contaminant load design criteria.
2 Install water- saving appliances whenever and wherever possible.
3. Repair even small water leaks as soon as possible.
4. Never pour grease or oil down any drain or stool.
5 Garbage disposals are not recommended; if you must have one, use it sparingly.
6 No paper products other than tissue should go into the system.
7 No chemicals should go into the system.
8 Avoid surge flows of water; try to spread laundry throughout the week.
Maintenance
1. The septic tank must be inspected every three years by a properly licensed person.
2 If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume
equals one third of the tank volume.
3. When the septic tank is pumped, any solids to the bottom of the pump tank must be pumped, and the filter must be back - washed into
the septic tank to remove accumulated material.
4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in -situ soil adsorption cell.
Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption
cell.
5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany
their specifications.
6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump.
If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve
capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or
two days should pass before any necessary repairs can be made.
7 Avoid compaction such as vehicle traffic within 15' down -slope of the adsorption system.
8 Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system.
9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth.
10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run -off into the system area.
Contingency Plan
Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring
may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54
(2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing,
and/or installation of additional treatment components or conversion to a holding tank may be necessary.
Page 8 of 8
I
ORIGINAL
2037
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing
Attach complete site plan on paper not less than 8% County x 11 inches in size. Plan must St. Croix
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.
040- 1037 -20 -100
Please print all information. Re ewed Date
Personal information you provide rnay be nv aw, s. 15.04 (1) (m)),
Property Owner Property Location
Feyereisen, Norman /Shirley Govt. Lot NE 1/4 SE 1/4 S 8 T 28 N R 19 W
Property Owner's Mailing Addre Lot # Block # Subd. Name or CSM#
429 Townsvalley Road
City fate ` p ifiber City _]Village a Town Nearest Road
Hudson I W - - 7 Troy I Townsvalley
New Construction Use: 16 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
✓, Replacement Public or commercial - Describe
Parent material sandy /loamy outwash Flood plain elevation, if applicable NA
General comments ✓/
and recommendations: instal "conventional" in- ground trench system @ system elevation of 92.0 w/ 0.7 gpd /sq ft loading
Boring # - Boring
601 Pit Ground Surface elev. 96.2 ft. Depth to limiting factor > 1 15 in. Soil p g 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 -16 10YR 2/1 - sil 2 f sbk mvfr gs 1m .6 .8
2 16 -33 7.5YR 3/4 - sil 2 f -m sbk mvfr gs 1 m .6 .8
3 33 -43 7.5YR 3/4 - sl 1 m sbk mvfr cs 1m .4 .7
4 43 -115 7.5YR 4/6 - s 0 sg dl - - .7 1.6
Boring # i Boring
46 Pit Ground Surface elev. 96.0 ft. Depth to limiting factor > 120 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 -18 10YR 2/1 - sil 2 f sbk mvfr gs lm .6 .8
2 18 -25 7.5YR 3/4 - sil 2 f -m sbk mvfr gs 1 m .6 .8
3 25 -38 7.5YR 3/4 - sl 1 m sbk mvfr cs 1 m .4 j .7
4 38 -120 7.5YR 4/6 - s 0 sg dl - - 7 1.6
Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L " E uent #2 = s --<,30 mg /L and TSS < 30 mgC
CST Name (Please Print) Si a re: CST Number
Henry F. Grote i 14 - 4 - 2
Address Certified Soil Testing Date Evaluation Conducted Telephone Number
E. 4366 353rd Ave., Menomonie, WI 54751 5/5/2004 715 - 233 -0398
Property Owner Feyereisen, Norman /Shirley Parcel ID # 040 - 1037 -20 -100 Page 2 of 3
F31 Boring # �jj Boring
0 Pit Ground Surface elev. 9 j6.6 ft. Depth to limiting factor > 120 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -14 10YR 2/1 - sil 2 f sbk mvfr gs 1M .6 .8
2 14 -30 7.5YR 3/4 - sil 2 f -m sbk mvfr gs 1 m .6 .8
3 30 -36 7.5YR 3/4 - sl 1 m sbk dh cs if .4 .7
4 36 -120 7.5YR 4/6 - s 0 Sg dl - - .7 1.6
F-1 Boring # _jI 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 '
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
I
i
I
F-1 Boring # Boring
I Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
I
� I
Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 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 -8330 (R.07 /00)
Certified Soil Testing
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LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02
REAL ESTATE TOWN OF TROY
COMPUTER NUMBER 040 - 1037 -20 -100 Parcel Number 8.28.19.123A
OWNER NAME: First NORMAN & SHIRLEE Last FEYEREISEN
PROPERTY ADDRESS: Hse # 112 PD -- Street Name -- Type SD Apartment
429 TOWNSVALLEY RD
SECTION 8 TOWN 28N RANGE 19W '/4160 '/440
Line Description Line Description
TOTAL ACREAGE 37.312 PLAT LOT BLK
01 SEC 8 T28N R19W 15
02 NE SE INCL RR R/W 16
03 EXC AS DESC 1674/381 17
04 18
05 19
06 20
07 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, 178- History, F10 -Exit
PAG JL
I A I k IlAlit ol. WJ.' 1-() 100 1 1 Mis IlEip �5 IGN:�Z - .7 1 7 7
WAUHANTY 00A) KATHLEEN H. WALSH
REGISTER OF DEEDS
Documont Ntpmt)nr ST. CROIX CO., WI
RECEIVED FOR RECORD
This De made be,,Lhn NORMAN AND SlJLR1.EE 07-05-2001 3:30 PH
J
BAN
-YEREIS "
i A. FE HIJ
WARRANTY DEED
....... ... EXEMPT #
Grantor, CERT COPY FEE:
and __ COPY FEE:
Troy TRANSFER FEE: 450.00
RECORDING FEE: 12.00
Grantee.
PAGES- 2
Grantor, for a valuable consideration, conveys to Grantee the following
described real estate in St. Croix County, State or Wisconsin
(the "Property"): Recording Aiml
i Name and Return Addre
Northeast guarter of the Sou ter and the
S4 theast - Quar ter wood S.C.
- uar�7 ortRe Southeast 2uarter
u- lea r
:)UttWgs-E-'&.u—art-e-r--oT--tEe—Southeast - ge — ction 8, L
roy, E. Cro County, Wisconsin, 0, t St., P.O. Box 125
'2 Cari,
H 14
dDescribed as follows: Commencing at the 11 H son, W1 54016
Southeast corner
Iof said Section 8; thence N 00'49'28" W (Bearings
0 1 ' ISW
referenced to the East line of said Southeast Quarter of I
iSection 8, assumed to bear N 00 W) 656.64' along ... .. .
Ilsaid East line; thence S 88 W 222.95' along a 040-1037-20
] ,Northerly line of the plat of Eagle Bluff to the point 040-1037-50
11 of beginning; thence South 88 W 577.05' along Parcei Identification Number (PIN)
!!said Northerly line; thence N 24 E 1056-64'; This — homestead property.
1 ! thence N 88'37'26" E 346-48'; thence S 00 ° 49' 28" E (is) (is not)
i 1635.83' along said East line of the Southeast Quarter; thence
Southwesterly 117.14' along a 267.00' radius curve concave Southeasterly whose chord bears
ilS 48 W 116.20'; thence S.35" 30' 00" W 121.30'; thence Southwesterly 156.93'
is
* !along a 367.00' radius curve concave southeasterly whose chord bears S 23 W
i!155.74' to the point of beginnin
I%E� PE 44 144 of Section 8, Township 28 North, Range 19 West,
�LSO
esc e "A A a Refd to.
This parcel of land contains 11.498 acres, more or less, being 500,831 square feet,
!;more or less, subject to easements of record.
li
it
Together with all appurtenant rights, title and interests.
1: Grantor warrants that the title to the Property is good. indefeasible in fee simple and free and clear of encumbrances except
I -
Dated ;his day of July 2001
—(SEAL) (SEAL)
g
Norman Feyerelsen A. Feyere
en
(SEAL) (SEAL)
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AUTHENTICATION ACKNOWLEDGMENT
i Signature(s) Norman and Shirlee A.
State of Wisconsin,
Feyerelsen ss,
County.
authenticated this f 2L Jy 2001 Personally came before me this day of
the above named
S-cmel R. Cari
TITLE: MEM - M - X1`f_BAR OF WISCONSIN to
(If not, me known to be the person who executed the foregoing
authorized by §705.06, Wis. Stets.) instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Heywood & Carl.S.C.
-- ID - 4 — Locust.St., Hudson, W1 54016
Notary Public. State of Wisconsin
My commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not
necessary.)
Names of persons signing in any capacity must be t or printed belo-w their signature.
STATE BAR OF WISCONSIN Wisconsin Legal Stank Co.. Inc.
WARRANTY DEED FORM No. I - 1998 Milwaukee Wis.
Vol_ .1674NCE382
EXHIBIT "A"
A PARCEL OF LAND LOCATED IN THE SE 1/4 OF THE SE 1/4 OF SECTION 8.
T28N, R19W. TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN, DESCRIBED AS
FOLLOWS: COMMENCING AT THE SE CORNER OF SAID SECTION 8, THENCE N 00 °49'28" W
(BEARINGS REFERENCED TO THE EAST LINE OF SAID SE 1/4 OF SECTION 8. ASSUMED TO
BEAR N 00 0 49'28" W) 656.64' TO THE POINT OF BEGINNING; THENCE S 88 0 37'26" W
222.95' ALONG THE NORTH LINE OF LOT 13 OF THE PLAT OF EAGLE BLUFF; THENCE
NORTHEASTERLY 156.93' ALONG A 367.00' RADIUS CURVE CONCAVE SOUTHEASTERLY
WHOSE CHORD BEARS N 23 E 155.74' • THENCE N 35"30'00" E 121.30'
THENCE NORTHEASTERLY 117.14' ALONG A 267.00' RADIUS CURVE CONCAVE
SOUTHEASTERLY WHOSE CHORD BEARS N 48 °04'05.5" E 116.20'; THENCE S 00 °49'28" E
314.17' ALONG SAID EAST LINE OF THE SE 1/4 TO THE POINT OF BEGINNING.
THIS PARCEL CONTAINS 1.004 ACRES. - MORE OR LESS. BEING 43.723 SQUARE FFFT
MORE OR LESS. SUBJECT TO EASEMENTS OF RECORD.
99-2417