HomeMy WebLinkAbout040-1116-90-000 J
• 1 + . • ` ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPORT ;A
Owner p R-� e F
Property Address 339 e�
City /State
Legal Descriptio I
Lot Block Subdivision/CSM #
- 5 L' ' /as '/4, Sec. 30 , T N -R_ftW, Town of I r- PIN #
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer e�S Size ST/PC 1 ooh / Setback from: House �a Well G( P/Q
Pump manufacturer Model
Alarm location
(HOLDING TANKS ONLY
Setbacks: Servi a road en a Water me
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
Type of system: Tvj \ I tg-Av lti' Width 3 Length 3 -1 - 30 Number of Trenches
Setback from: House `� S' Well B O P/L a V Vent to fresh air intake $ 5
ELEVATIONS
Description of benchmark `� N C �� `� °i ' �` Elevation
Description of alternate benchmark Elevation
Building Sewer ST/HT Inlet �� ST Outlet �� PC Inlet
Q �I
PC Bottom Header/Manifold I G O Top of ST/PC Manhole Cover �� • '
Distribution Lines
Bottom of System
Final Grade () () q U () 1 5 U qlJ
Date of installation a / 1 Z number 337 --�, Z State plan number
Plumber's signature IJ Y — License number D a a 9 U V Date 3/ 9/ OU
Inspector Ko �
Complete plot plan
NOTICE Please provide the following:
• A plan view sketch showing everything within 100 feet of the system.
• Two horizontal reference points to center of septic tank manhole cover.
• Show alternate benchmark, if applicable.
PLAN VIEW
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INDICATt NORTH ARROW
Wisc+inbepartment of Commerce PRIVATE SEWAGE SYSTEM County:
Safety and Buildings Division INSPECTION REPORT t/
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: X
Personal information you provice may be used for secondary purposes [Privacy Law s.15.04 (1)(m)]. 338932
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
GRABER, JULIE /WILD, MARY TROY
CST BM Elev.:- Insp. BM Elev.: BM Descriptio . l/ Parcel Tax No.:
1.51 I v e — { ST'} IgN�I 040 - 1116 -90 -000
TANK INFORMATION ELEVATION DATA
TYPE ' M CAPACITY STATION BS HI FS ELEV.
P'.. VV ���� Ben
e ti
Dosing
Aeration Bldg. Sewer
Holding t Inlet Y.53 ' 97 s'
TANK SETBACK INFORMATION Outlet ,$ Z
TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet
Air I
'L- NA Dt Bottom —
Dosing Header / Man.
Aeration Dist. Pipe; ;� ��� re
Holding Bot. Syste L `
mT- 7,09
PUMP/ SIPHON INFORMATION Final Grade $ �,
Manufacturer T 7 of 4�' y, h!c
Model Nu er GPM _41° 4
TDH Li Friction S s TDH Ft 93
Forcemain Length Dia. Dist. To well
SOIL ABSORPTION SYSTEM
BED EN Width r LengthZ No. Of r ches PIT No. Of Pits Inside Dia. Liquid Depth
DIM N 3 DIMENSION
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LE CHING ManufactuLrer:
INFORMATION SypeO 61 OR UNIT
7 /� // Model Numbe ,
/7 �.
DISTRIBUTION SYSTEM
Header / Mani old Distribution P.ipeJ w 7 x V ole9ze x Hole Spacing Vent To Air Intake
Length � Dia. Length Bia. 5 Spacing d;• —S �'vuG Llrs
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over er xx Depth Of xx Seeded/ Sodded xx Mulch
Bed /Trench Center e Toosoil ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: TROY 30.28.19.475C,SE,SW 339 GLENMONT ROAD
�' 1 c �• t wry o wP -�.�� F . S , 6 U jf W-e s o, s_
Plan revision required? ❑ Yes J�J
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspector's gnature Cert No
1 46� Safety and Buildings Division
onsft SANITARY PERMIT APPLICATION Po X ashihinngtonAve.
Department of Commerce In accord with ILHR 83:05, Wis. Adm. Code Madison, WI 53707 -7969
• Attach complete plans (to the county copy only) for the system, on paper not less co unt
than 8 1/2 x 11 inches in size. C
• See reverse side for instructions for completing this application State sanitary Permit Number
3 S;k
The information you provide may be used by other government agency programs ❑ Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION I `""
Pr rty Own r am Property Location
SC 1/4 a ) 1/4, S U T N, R/ E (or) W
Pro a ty Owner's ailing Address Lot Number Block Number
tate rQ Zip Code Phone Number Subdivision Name or CSM Number
II. 'TYPE F B ILDI G: (check one) ❑ State Owned ❑ ltr N rest Road
Public 1 or 2 Family Dwelling - No. of bedrooms J Town OF r4o Lr
III. BUILDING USE (If building type is public, check all that apply) Parcel TaxNumber(s) 1 270,2$, 11. 4`TSC
1 ❑ Apartment/ Condo OA140 - 1146 _ Fe� - 060
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 [1 Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable)
A) 1. ❑ New . 2 Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an
System ______ ______
System________ Tank Only______________ Existing System _________Existing
System
B) E] A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 []Holding Tank
12 54 Seepage Trench 22 ❑ In- Ground Pressure / f 42 El Pit Privy
13 E] Seepage Pit (\ � 43 E] Vault Privy
14 E] System -In -Fill �; k-4 �'r y
VI. ABSORPTION SYSTEM INFORMATION!
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate r JIS 1 s 7. Final Gr g
u rr�� Requiir q. ft.) Proposed (sq. ft.) (Gals/d y /sq. ft.) (Min. /inch) d 4� f.0 e i�n t S V (� •S+, Feet t9 <ta
Cap acity
VII. TANK in Ca allons Total # of Prefab. Site Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturers Name Concrete con Steel glass Plastic App
New Existing structed
Tanks Tanks
Septic Tank f UUU e $ 19 ❑ ❑ ❑ ❑ ❑
lift Pump Tank /Siphon Chamber ❑ I ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plu N • (Print) Plumber's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number:
Plumber's Address (Street, City, State, Z Code): V I
�v
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing ge t Signature (No Stamps)
Approved ❑ Owner Given Initial Surcharge Fee) c,
Adverse Determination ( a° hco uJ
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBIC14M IRA 1W) DI STRURMON: Original to county. One can To: safety & Buildings Division, owner, PkuW
INSTRUCTIONS `
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a 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.
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. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licened pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608 -266 -3151.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII_ 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.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 1/2 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; pump or siphon
tanks; 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; and F) all sizing information.
----------------------------------------------------------------------------------------------------
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
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1At4coasin Department of Industry SOIL AND SITE EVALUATION 2
Labor and Human Relations Page of
bivislon•of Safety and Buildings in accordance with s. ILHR 83.09, Wis.
Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must County d
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. #
LIA
APPLICANT INFORMATION - Please print all Information. Rev wed by Date
Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). •J 19�
Property Owner -4 Property Location
W�GD i �+�• G1��4t3E'R Govt. Lot 5 .9 1145 1A1 1/4,S O T 26 ,N,R I E (or W
Property Owner's Mailing Address Lot # I Block# I Subd. Name or CSM#
33 f 6:A vlke vT S
City f
State g Zip Code Phone Number �/ _/ Nearest Road
Rill 7 /��s �// S�oL ( ?�S ZS • �7�0 ❑ Clty [� Vill ge ('' own 6/j(1140�T RV-
El New Construction Use: Residential / Number of bedrooms Addition to existing building
�Replacement El Public or commercial - Describe: �(/�ND
Code derived daily flow % �/ �O gpd Recommended design loading rate N�bad, gpd/fl - trench, gpd/11
Absorption area required bed. ft trench, ft23 Maximum design loading rate bed, gpd/ft • & trench, gpd/it
Recommended infiltration surface elevation(s) It (as referred to site plan benchmark)
Additional design /site considerations W sE nge 11- lSyaLog w/ VAyoe /1 ' ay- 191S7�` �y
&C
Parent material IOESS 0✓� 0&? - ,4V S4 - Flood plain elevation, if applicable N ft
S = Suitable for system �Conventional Mounr+ -, / InG�round ressure S AT -Gr a System In Fill Holding Tank
U = Unsuitable for system I� S❑ U ❑ S lJ U L 5 El E 'S El El S El S U
SOIL DESCRIPTION REPORT
Boring Horizon Depth Dominant Color Mottles Structure GPD /ft
g Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
1, r
0-8 10Y 3 13 oF L- 2 .fft ��' 4, -t' 6C
- CAM ,f'cr�=D S/L 2„ � fi' Q,�• � N '--_
Ground
aw 7n �ft. �- l�/ i� V/? 3/y $ /_ 2 Sh,& fe 4 s
t - •3 sY� Y!
Depth to r� /_
limiting 3 ' SG 7 ' SYQ GAS �/� C s '-
factor Remarks: ts.96 - - - -- -
Boring #
•2 f i0 yK 2f3 �D.�r A crED SL 2,N, Pe nv,f l ' a ,c' ! -F N ' u
2 - s yj 7s
Ground /D J� S. — '_ . ? •�
C�• elev. �a
/D t To L�� v�
Depth to
limiting
f ain Remarks: 1V0 /ZC p/�Ol� /E /.y / ��S -t/,f77,(, l
CST Name (Please Print) Signature Telephone No.
, -Q0 7 Z4 R icy 713 . 3,?6 • Pld> S
Address Date CST Number
2L
Private Sewage Consultants
655 O'Neil Rd. , "~
Hudson, Wis. 54016 �. ) 1
r
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RECEIVED
APP 1 5 1995 _p
S ^ C R OIX
VI 'a
Nt�
- ✓�, XQNihtfnOFFfae - f � /
i�- SOIL DESCRIPTION REPORT 2
PROPERTY OWNER Page - of
PARCEL I.D.If
Boris # Horizon Depth Dominant Color Mottles Structure 2
Boring Texture Consistence Boundary Roots
t in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
3 3 •(� /o S/ie3/ L- r� 4• R
YX
Ground TX 7/ s/ -2_ r ilz M1 75 q
S • cP
elev.
f 1/
Depth to --
limiting
factor
Remarks:
Boring #
.x
Ground
elev.
Depth to -
limiting
factor
in.
-- Remarks:
Horizon Depth Dominant Color Mottles Structure GPD /ft
Texture Consistence Boundary Roots
In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring # ;
Ground
elev.
ft.
Depth to ;
limiting
factor
in. Remarks:
Boring #
0"
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
SBDW -8330 (R. 08/95)
IMPORTANT NOTE TO OWNERS & INSTALLER: All the finer textured
soils (loams,silts, etc.) can & will be easily smeared Or
compacted even by a backhoe bucket during trench construction.
When this occurs premature failure will result. As per ILHR 83.13
(1), the installer MUST be very careful to properly hand rake
te sidewalls & bottoms to re- expose all of the soils natural
structure. Minn. even recommends that scarifying devices be
mounted on the sides of the bucket. Only in this way can
treatment & absorption be most enhanced for normal longer
system life.
SST : 70 0 F
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P�Ivate sewage consultants
6m owell Rd.
5 -0 Hudson, Wis. 54016
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-- 3 of 3
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/A.t�r _ u i e K r b �.,,a Pkn r .j K w d A
Mailing Address 3 3 q t �, ,,,,� - 't RA -; v e✓ In 11-
Property Address
(Verification required from Planning Department for new construction)
City/State ► v e l g Parcel Identification Number O Lq D— 1 11 b -- 4 D- D Op
LEGAL DESCRIPTION
Property Location S %, S w Y Sec. 3 D . T a.9 N -R Lcj_ul, To %vn of
Subdivision Lot #
Certified Survey Map # Volume . Page #
Warranty Deed # ^I b, '`1 Volume 0 Page # y j
Spec house O yes lk no Lot iines identifiable Q yes 0 no
SYSTEMVIAINTENANCE
Impwperme andmaiateaanaeofyoursepticsysbemcouldremkih itsprematunefailuceto baadtewastes. Propermaimbmm=
consists of pumping out the septic tank evety dmx years or sooner if needod by a Iiceased pumper What you put into the system
can affectAte function of the septic tanlc . a treatment stage is the wastedisposalsyste=
The pmperty owner agrees to submit to St Croix Zoning Department a certification f signed by the owner and by a
P IOumgYm=Phwixx restiictedphrmber or a H=scdpnnperverifying that (1) the m-site wastewaterdisposd system
is in Proper operitting condition and/or (Z) after inspection sad pumping.(if necessary), the septic.tank is less than 1/3 full of sludge.
Uwe, the wed have read the above requite and agree to maintain the private sewage disposal system with the standards
set forth, heaein,'as set by the Dena hncnt of Commence and the Department of Nat
r l Rest
stating that your septic ; State of Wisconsin.. Certi�catioa
system has beta maintained must be completed and returned to the St Croix Zoning Office within 30
days of the three year tion date.
CTWTURB OF APPI.ICAN'I' DATE
OWNER. CERTIFICATION
I (we) certify that all statements on this form are true to. &e best of my (our) knowledge. I (we) am (are) the owner(s) of
the property described a e, by virtue of a warren deed recorded in. Register 9Mceds Office.
�a ATURE 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: 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
DOCUMENT NO. STATE B:! R O^ WISCONSIN FORK 1 -19U THIS SPA-'% RESERVED FOR REGOR01116 DATA
r WARRANTY DEED
4 ' VOL t7�U 'r'A t "1
_ - - E
REGISTR'
5 OFFICE
This Deed made between Clayton J Welch, a ST. CROIX C O., W'
single. person _ __ - --
Recd for Record
Grantor, Gt 1 991
and Julie _MA_ Graber ,and Mary K&..Wild, - as joint _ 11:20 � A. M
tenants.with full survivorship rights.,
- - Re9isMr of Dew
—.. Grantee,
Witnesseth, That the said Grantor, for a valuable consideration. -_ -.
RETURN TO
conveys to Grantee the following described real estate in ..St. CrolX - -. -
County, State of Wisconsin:
Tax Parcel No: ...................................
East 160' of the West 972' of the North 272.25' of
that part of the SEk of t'e SW;4 of Section 30,
T28N, R19W, St. Croix County, Wisconsin lying
South of the Centerline of the Town Road.
I
FEET
i
This - is _ .._ "_. .... homestead property.
(is) (WXdt )
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And Clayton J Welch
warrants that the title is good, inuefeasible in fee simple and free and clear of encumbran,es except
easements, restrictions and rights — of — way of record
and will w•an"ant and defend the same.
Dated this 14th .. _ day of June 19 91
ISEAL�
Clavton J. Welch
_ (SEAL) (SEALi
AUTHENTICATION ACKNOWLEDGMENT
Signature(,) __- _ --- STATE OF WISCONSIN '
�3.
. . ................... .. -- _.._.. - K Pierc
authenticated this _ _. day of -- ----- 19. -_ Personall; came before me ti::s 14th day �f
_ - Jane - - 19 9.1.. the above nnm ,'
C arton J. W
TITLE: MEMBER ST:1TE BAR OF WISCONSIN
(if not,
authorized ht 0ii .Oft. Wis. Stats.)
to me km to he the ncrsmi •.v!:(' ,•xr, Ited t ^e
fr.ret;oing instnrmant and at'knotvb•d e tl.e 'ar'e
7"IS ;'Aj'v. "VT %AS OFaP-cD Pv
Steven B. Goff, attorney - at Law } t \^ • T � k "\ "
710 North Main Street, Box 167 Mary A. ,. o!1Nbde
River Falls, Wisconsin 54 Q 2 ;,t.,•" , Plhlic xx.giK.,)k Pie_rcg- .,.,...,
may he .r : ;Oitnticafed or :iAn- :%0 R.,th \ �'nn.ui <sinn is prr.N.r.: not, stat,• ex:- -:t% -
:Ir1• m"•� rr�.,.,,.: ;a.}.) ,lar.,-
Apr i' - 24 � - l:a 94 .�
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94
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Edina
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homeprofile
DIRECT: (715)386 -0254 339 Glenmont Rd River Falls, WI $1 , 0
METRO: (612)436 -7072 Ext 254
EDINA REALTY: (715)386 -8236
offered by
• ed -'.
P
e Reid
pa.-' 'r
# A„
r
6 AAA .
OUR 1���:
ns
bccomo your family mattcrEs moAL
highlights W W ood ed etting
A wooded wonderland compliments this wonderful rambler.
This country setting is only 7 miles south of Hudson with convenient access to 1 -94. Only 20 minutes to St. Paul!! Many updates
include: Aluminum Soffits /Facia, Roof, Windows, Deck and Baths. Enjoy the convenience of a main floor office plus a lower level
walkout. Sellers would prefer no earlier than 5130199 closing. Great landscaping makes this home complete.
CALL NANCI JOHNSONAT 386 -0254 NOW!
This Home has Edina Realty's Home Plus —A Home Inspection and Warranty Program. A wonderful program that
eliminates worries for Buyer's. Ask for details!
ITEMS INCLUDED Refrigerator, Dishwasher, Microwave, Water Softener(owned), Water Purifter(owned), Garage Door Opener,
Window Treatments, Mirrors on Walls.
NOTINCLUDED Stove, Washer, Dryer, Seller's Personal Property
LOCATION DIMENSIONS PROPERTY
Directions: I -94E, Exit #2, Main Level: Style Rambler
S. on Carmichael/Cty Rd F, Living Room 22'8" x 11'6" Year Built 1971?
W. on Gienmont Rd, Dining Room 12' x 12' Baths Full - Main Level
Home on the left Kitchen 12' x 11'9" Full - Lower Level
Bedroom 10' x 8'3" Exterior Wood/Brick
Legal Description: Bedroom 10'3" x 9'3 Heat FA/Propane
Sec 30 T28N R19W Den - Office 14'8" x 107" Central Air Yes
E 160' of W 972' of N. 272.25' Lower Level: Lot Size 1 Acre
of that point of SE SW lying S. of Cen Ln Master Bedroom 15'x 10'6" Taxes $1550.72 1998
Of Town Road Recreation Room 16'8" x 107" TFF 1872 sq ft
Exercise Room 14'2" x 1010" Garage 2 Car detached
PID # 040 - 1116 -90 -000 Utility Room 10'x 13'
ER769 Information deemed reliable but not guaranteed. ®'