HomeMy WebLinkAbout038-1132-19-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division —
INSPECTION REPORT Sanitary Permit No.
538808 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)J.
Permit Holder's Name: City Village X Township Parcel Tax No:
Simpson, Robert & Jo Trust Star Prairie, Town of 038 - 1132 -20 -115
CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No:
�Op �c �o� 0P 32.31.18.541A15
TANK INFORMATION ELEVATION DA
TYPE MANUFACTURER ,'^� CAPACITY STATION BS HI FS ELEV.
Septic /) J (J Benchmark /�
7 ficJ U . /aQ
Dosing Alt. BM
Ir l.Lc.� r� Co 6.3 /bD . 1-
Aeration Bldg. Sewer 5. 3
J ' 75 , • 1
Holding � St/Ht Inlet
G• 3 5 47 b
TANK SETBACK INFORMATION St/Ht outlet
55 93
TANK TO P/L WELL LDG. Vent to Air Intake ROAD Dt Inlet
4 6 j d-t 5� o ur- a t tka•
Septic / -7 Z7 Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe
Holding Bot. System
PUMP /SIPHON INFORMATION Final Grade Z • 3 q$
Manufacturer Demand St Cover �—
GPM
Model Nu
T Lift Friction Loss System TDH Ft
Forcemain Dist. to Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No, Of Pits Inside Dia. Liquid Depth
DIMENSIONS e ,_1 _ ` \ -- --
SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer
INFORMATION CHAMBER OR
Type Of System I Z a UNIT Model Number
0.9. cl z
DISTRIBUTION SYSTEM 16M
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s) G
Length 1-1 Dia Length Dia Spacing \ �' ✓ $ e
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
Bedlrrench Center �• 5 Bed/Trench Edges Topsoil ---g1es E No ; Yes ^ ' No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: 1818 Winding Trail Rd New Richmond, WI 54017 (SW 1/4 SW 1/4 32 T31 R1 8W) NA Lot 1 Parcel No: 32.31.18.541A15
1.) Alt BM Description = F' 6 (1- G� a ; �, S �— � a C— S O A-
2.) Bldg sewer length = 3 7
- amount of cover = /
6
Plan revision Required? ❑ Yes DKNo
Use other side for additional information. C Z� k - ]
;
Date Insep is Sig ure Cert No
SBD -6710 (R.3/97)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
538808 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:
Simpson, Robert & Jo Trust I Star Prairie, Town of 038 - 1132 -20 -115
CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No:
32.31.18.541A15
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer
Holding St/Ht Inlet
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Et Bottom
Dosing Header /Man.
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer Demand St Cover
GPM
Model Number
TDH lift Friction Loss System Head 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. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer
INFORMATION CHAMBER OR
Type Of System: UNIT Model Number:
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s)
Length Dia Length Dia Spacing
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 Bed/Trench Edges Topsoil
Yes 0 No 0 Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: 1818 Winding Trail Rd New Richmond, WI 54017 (SW 1/4 SW 1/4 32 T31 R1 8W) NA Lot 1 Parcel No: 32.31.18.541A15
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Plan revision Required? ❑ Yes ❑ No
Use other side for additional information.
- -
Date Insepctofs Signature C"t No
SBD -6710 (R.3/97)
er Mi. afety and Buildings Division County � �� r t�
201 Washin on Ave., Box 7162
lt l�si S 1 2 6 O 1 1 Madison, WI O (7� Sanitary Permit Number (to )e filled in by Co.}
of omm i Q' D43 Sa ital lm lieation State Tramsactio umber
In accordance with s. Comm. 83. ts. dm. Code, submission of this fonn to the appropriate governmental IVA
unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different han mailing address)
submitted to the Department of Commerce. Personal information you provide may be used for secondary
p urposes in accordance with the Privacy Law, s. 15.04(1 )(m , Stars. , _
I. Application Information - Please Print All Information $� (�(J/ 1 � r
Property Owner's Name parcel #
Proper / Owner's Mailing Address Property Location I
/ jGZA t7 �l Govt. Lot ♦� `
City, State Zip Code Phone Number , ` j� ,
u / 1 r circ le o�
r 7� N R EtCir V1�
II. Type of Building (check all that apply) of # v�
1 or 2 Family Dwelling - Number of Bedrooms �^ Subdivision Name
/ 0" r�{�,
❑ Public /Commercial - Desc City of ribe se L el * • -
❑ _
❑ State Owned- Descrt se CSM Number ❑ Village of�__
own o
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A" �Stem ❑ Re lacement S stem ❑ Treatment/Holdin Tank R lacement Onl ❑ Other Modification to Exis in S stem ex lain P Y g Replacement Y g
Y (explain)
)
B. El Permit Renewal ❑ Permit Revision ❑Change of Plumber ❑Permit Transfer to New
List Previous Permit Number s nd Date Issued
Before Expiration Owner
�� t a 4m,
,Type of POWTS System/Component/Device: Check all that appl
on- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable sot!
� n� - Zolding Tani: ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dispersal/Treajdnent Area Informati : 2 u/
Design Flow (gpd) Design Soil Applicati Rate(gpdsf) Dispersal Area Required Dispersal Area Pr osed (s stem Elev ation
o2e7
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units o
New Tanks Existing Tanks / o Y 5
Septic or Holding Tank y
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assn 2e gonsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) �b MP/MPRS Number Business Phone Number
ca ze i 0 ssue L
Plumber's Address (Street, City, State, Zip de _
&, - 1� C 4�j
VII oun /De artment Use Onl
pproved Disapprove Permit Fee Date I sued Issuin ent Sign
❑ Owner G' eason for De
IX. Conde easons for Disapproval \ ��
� .Septic tank. efllueM Piker and 3 'n� � 1 r ��'l �"1�(G
dispersal cell must all be services t maintained
at per management plan provided by plumber. l
2. ':,iAtstk8ckraegtr "gments must be maintained
Attach to complete plans for the system and submit to the County only on paper not less than 8 to x 11 inches in size
SBD -6398 (R. 02/09)
PLOT PLAN
PROJECT Robert Simpson Trust ADDRESS 543 S. Shore Dr. Forest Lake Mn 55025
SW 114 SW 1 /4S 32 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 7/21/11 GPD 77
CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 280 LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 205 # of chambers 10
,BENCHMARK V.R.P. Garage Siding ASSUME ELEVATION 100 Filter BEST Filter
❑BOREHOLE O WELL IH.R.P. Same as Benchmark
SYSTEM ELEVATION 94.5' 5' below qrade
Well is to meet all
setbacks required by
WDNR
Property Line Vent /
� Quick4 Standard -W
Existing house
Well of Cover Leaching Chamber
with 20.0 ft2 of Area
50' 5.8ft ^2 /pair of end caps 65
4' Long 12"
3 4" Grade at System Elevation
Plans Designed Using
Conventional Powts
Manual Version 2.0 Scale is 1" = 40'
250' unless otherwise
noted
2 persons and 1 floor drain to equal 77 gpd
Existing (the only way to size this low usuage)
Garage
30' 40'
7% slope S
25' 15'
B -1
20'
50' B -3
0'
1 -3' X 42' cell
250 98.5' vent 10'
B -2
99.5' Winding Trail Road
Cover Page
Shaun Bird
Bird Plumbing Inc.
1008 192nd Ave
New Richmond Wi 54017
715- 246 -4516
Date: 7/21 /11
Owner: Robert Simpson Trust
Location: SW1 /4 SW1 /4 S32 T31 N,R18W 1818 Winding Trail Road Star Prairie
System type: In- ground absorbtion system (conventional)
Manuals Used: In- ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4 -5. Maintanance an Contingency Plan
6. Filter Specification eet
Signature
License numb r 226900
PLOT PLAN
PROJECT Robert Simoson Trust ADDRESS 543 S. Shore Dr. Forest Lake Mn 55025
SW 1 SW 1 /4s 32 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 7/21/11 GPD 77
CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 280 LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 205 # of chambers 10
BENCHMARK V.R.P. Garage Siding ASSUME ELEVATION 100' Filter BEST Filter
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
Well is to meet all SYSTEM ELEVATION 94.5'5' below qrade
setbacks required by
AL WDNR
Property Line Vent /
>6" Quick4 Standard -W
Existing house Leaching hamber
Well of Cover with 20.0 ft2 of Area r ,,�p
50' 12„ 5.8ft ^2 /pair of end caps Pi `" f
4' Long
3419 Grade at System Elevation
Plans Designed Using
Conventional Powts
Manual Version 2.0 Scale is 1" = 40'
250' unless otherwise
noted
2 persons and 1 floor drain to equal 77 gpd
Existing (the only way to size this low usuage)
Garage
3 0' 40'
7% slope S
25 15'
B -1
20'
50' B -3
0'
1 -3' X 42' cell
250' vent
98.5' 10'
B -2
99.5' Winding Trail Road
Cross Section of Quick 4 Standard -W Leaching Chamber
Typical cross section for 1 of 1 cells
Intial Grade Elevation
Quick 4 Standard -
To be >1' above grade Leaching Chamber 99.5'
with 20.0 ft2 on Area per Finish grade elevation
Chamber 5.8ft 2 pair of
end plates
Typical Installation
Vent Grade
4 4' "
��30/34
From Septic Tank
4' Long 2 )f
3 4 "
Grade at System Elevation
1 -3' X 42' Cell
Same on other end Observation tubeNent
Located at end of cell
A
10 chambers per cell
System elevations:
A-94.5'
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREDgNT
AND
OWNERSHIP CERTIFICATION FORM
Owne9rBuyet
Wi Address
PropertyAddrm
I ( V er fflcxdm required frox O PIMM & Zoaiag Dept fnr new c�n$trmc iami.
CitylStato
Parcel Identification Number
MEGA?.
32— T N of
Property Locatioat GcJ 1 /4 , �C__ __c� 1 /4 ,Sec. R�W, ToW]i
Lot #
Subdivision .
Page #
Certified Survey Map #
Volume _ ,
Volume 3
Warranty Deed #
Lot HM idle no
SYS TE, "�" • ='�'n',•S sxtcF exD OWNLI CE R'r''t�CATION
ofp could in ib pry fad to e - W y
use and of y ld zesult d pump a.
msinwuawe co Whst you put rat°
nsists ig oat septic tookaver}'tbree su e>ooa,ez, if need,al sY+y a
took as i t
treatment titage m the waste disposal ; 0w= the System can affect the won of i3tee septic 12 - SL Croix Coca ty Samt�'
r ilxas are speeded in §ComM 83.52(1) and in Cbapt�cr
Planning a �g D°1t a won form' signed by the
'Ilse property o wner agr ees to subunt to St C roix Count or a licensed pub verifying t (1) the oan -site
o � } disposal systwn is is iaolxa' °A�°g�oomditk m and/or (2) arbor map ( may)• & septic tank is
less than 1/3 full of sludge: with the
I/we, the undwr ft ed have read the above requ and age eo to amiatamof14st atie aal R�eavm OM S`OO of Wisconsin
Awdards set fob, bareia. as set by the D � and zehnsted t0 ft St Croix County plamun8 &
C that
stating Your sysbart .
Zoning DeparMent within 30 days of the three year mpitatiom dare.
I/we certify that all s on this form are true to the best of may /our k O wIll8e. I'" mare tlu owaer(s) of the
property daeadbed above, by virtue of a ware V deed recorded m Rg3111 of Deeds Office.
Number of bedrooms
DATE
�Sj
** *Any infotmmtiom that is 9Dutod may result in the sanitary Permit being revoked by the Pb=iag Z=bg DepaztueU *s*
deed fxnm the Register of Deeds Office and a copy of the eaad&d survey map if
Include with this applicxtiom s recoxded warranty .
refer is made is the wwmty deed.
(REV. OMS)
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the cells.
4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive over system.
7. Watershed is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
Contingency Plan
Option #1. If system fails, determine cause of failure, use alternate area and install new
system in tested replacement area.
Option #2. Install system at a lower elevation, by removing chambers, removing biomat,
and install new system.
Option#3. No adequate area is suitable for replacement area, and system elevation
cannont be lowered. Install holding tank as last resort.
3. Replace any other failing components as needed.
Plumber: Shaun Bird 715 - 246 -4516
St. Croix County Zoning 715 - 386 -4680
Pumper Tom Mondor 715- 246 -5148
Shaun Bird #226900
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Wisconsin Department ofComme R ��'E IV J CO ALUATION I D Page of
Division of Safety and Buildings
in accordance wftWis. Adm. Code ` I � County � Attach complete site plan on pa not les 'th 1 1ze. Plan must include, but not limited to: vertical nd
hoa*prLtal re direction and Parcel I.D.
percent slope, state or dimension pr w¢a � nce to nearest road. � 3 3 — 1 3a 1; D f1J c Review by D t
Please printtaa in or r�in y rl ra ��•�
Personal information you provide may be used for secondary purposes (Privacy Law, s. / 5.04 (1) (m)).
Property Owner Property Location
p. j Govt. Lot . 6 J 1/ 1 /4 S T3 N R E (o W 1 Z 5 Property Owner's Mailing Add ess Lot 11 Block # Subd. or CSM#
sy 5, s r . U v � a169
City State Zip Code Phone Number ❑ City ❑Village Town Nearest Road
r -5506 1 r'- non
lo New Construction Use: Residential / Number of bedrooms 40 Code deriv desi w rate 7 2 r GPD
❑ Replacement .L ❑ Pu is or commercial - Describe: sSP o - lL- ?' _Z s i _' �gp
Parent material GLs Flood P6inelevatio, if applil ble ft.
General comments
and recommendations:
System Type �UYt�e�� 1:� System Elevation �y
I Ong # 0 Boring 9y/3
Pit Ground surface elevl ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I •Eff#2
D `l3 10 r 31 zl -
2 3 .;
lab
I
1
(
Boring # a Boring f
Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
3A- 4Z 1_1Z1 I Ib 112:1
J
ti
• Effluent #1 = BOD > 30 220 mg/L and TSS 30 < 1 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Marne (Please Print) lure CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 1 715- 246 -4516
Property Owner _ Parcel ID # Page of
a Boring # ❑Boring y�( - -7 �J // �
n
it Ground surface elev. 0 J ft. Depth to limiting factor T i� i.
Soil Apprication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
L 2 - y a
F-1 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 GPDAf
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
❑ Boring
a Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil Application Rate
Horizon 'lepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mgll. ' Effluent #2 = BOD 130 mglL and TSS < 30 mglL
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 - 2648777.
SBD4330 (8.6(00)
Soil Test Plot Plan
Project Name Robert Simpson Trust Shau
Address 543 S. Shore Dr.
Forest Lake Mn 55025 M #226900
Lot Subdivision --- ------ Da 7/21 /11
S W 1/4 S W 1 /4S 32 T 31 N /R W Township StarPrairie
Boring 0 Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Bottom of siding
System Elevation 94.5' *HRpSame as Benchmark
Property Line
Well Existing house
50'
Scale is 1" = 40'
50' unless otherwise
noted
Existing
Garage
7% slope 40'
25' 15'
B -1
20'
50' B -3 No
50'
250'
98.5' 10'
B -2
99.5' Winding Trail Road
U 2493P 133 7 7
KATHLEEN H. NALSH
REGISTER OF DEEDS
Document Number QUITCLAIM DEED ST CROIX CO., WI
RECEIVED FOR RECORD
CHRISTIAN B. SIMPSON quit claims to ROBERT W.
01/16/2004 09::30AN
SIMPSON AND JOY SIMPSON IRREVOCABLE TRUST, QUIT CLAIM DEED
Christian B.. Simpson, Trustee and John S. Simpson, EXEMPT # ib
Alternate Trustee, the following described real estate in St. REC FEE 15.00
TRANS FEE:
Croix County, Wisconsin: COPY FEE:
CC FEE:
Lot 1 of Certified Survey Map recorded PAGES: 3
Recordino Area
October 30, 1989, in Volume 8, at page 2168 Name and Return Address
as Document No. 453053 in Register of Deeds Gaylord
Ga l L.
Office -St. Croix County, Wisconsin and a non- C. C. L. Ga l Law
exclusive easement for ingress and egress P. o. Box 46
shown as private roadway easement on said River Falls, WI 54022
plat.
Excepting those portions described in Exhibits
A and B, attached hereto as if fully set forth
herein. 038- 1132 -20 -115
(Parcel Identification Number)
This is not homestead property.
Dated this >/ day of �cc , 2003.
" Christian B. Simpson, Trustee of the Rafrart W. Simpson
and Joy Simpson Irrevocable Trust
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
PIERCE COUNTY
authenticated this day of 2003.
Personalty came before me this 1 day"t� r�"'"•
2003, the above named Christine B. Simppgn, tome
Signature known to be the person who executed Hie, fdregolpg,
instrument and acknowledge the sarri&:. t ',
Type or print name
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, C. L. Gaylord, NotaryjPublic
authorized by Section 706.06, Wis. Slats.) State of Wisconsin
My commission is permanent
THIS INSTRUMENT WAS DRAFTED BY «..'
C. L. Gaylord, Attorney
P. O. BOX 46 'Names of persons signing In any capacity should be typed or
River Falls WI 54022 printed below their signatures.
453053
CERTIFIED SURVEY MAP
Located in part of the SW'k of the SW'h and in part of the NW; of the
SW4, all in Section 32, T31N, R18W, Town of Star Prairie, St. Croix
County, Wisconsin.
OW NER
++ 3
WI Corner of Russell Flandrick N N
Section 32 R.R. 4 Box 192 N ro
New Richmond, WI 54017
M
V
Unplatted Lands
O N --- - - - - -- - - - --
4 W o [n
-
� s M
N
L O
19' S89 0 29 1 03 'E
North line of the SWI of the SWI of
Section 32 \ d
LOT 1
257,334 Sq. Ft.
N 5.91 Acres
3 N 4 FROM SET 11PIP Z3. 69'
E
H , 639.12' Q Rl �
° i s N89 0 43 1 13 "W 708.62' M
�M
o Small Tract
o J N
d I' — N69 ° 39'S9 "W, 30.76'
FROM SET P
13
N89 0 39 1 59 1 OW
cO M - 100.00' (recorded as N89 °18'CO °W)
m =' - LEGEND _ Z
a - Lot 1
m C_e_r_tified Survey Map B County Section Monument Found t'>
N - - -- - - -- - 3
Vol. 5, Pg. 1375 It" Rebar found OCT 3 01989►
o • 1" Iron Pipe Found
J
Rog
SW Corner of O'COANELL 4
Fi Star of DOSd3
o 1" x 24 Iron Pipe Set, weighing SL Croix Co.,W1
b Section 32
0 1.68 lbs. per linear foot. (�
a Existing Fenceline
Drainage Area
SCALE IN FEET `a aa l �trL "cam
0 100 200 400
AL LSN C.
APPRCAM OCT
?� w H
OCT 3 0 1989 aoa
Am
This instrument drafted by Fran Bleskacek Proj. No. 78 -32 -189
VOLUI - 1E 8 PAGE 2168
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AS BUILT SA STC - 104
NITARY SYSTEM REPORT
OWNER
ADDRESS ? I
C� L
SUBDIVISION / CSM#
SECTION ��f LOT # �
T `_1 N- R -`.� Town of
ST. CROIX COUNTY, - Q r � rr �� 1
WISCONSIN
PL AN SHOW EVERYTHING WITHIN IN100 FEET OF SYSTEM
1
trod Iwr lfevr- i
re a
sa
J
INDICATE ORTH ARROW
Provide setback and elevation information on r
Provide 2 everse f this form.
dimension to center of septic tank manh le cover.
Wisconsin Department of Industry PRIVATE SEWAGE SYSTEM County: —
La n Human Relations
Sa fety INSPECTION REPORT ST. CROIX
fety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 289361
Permit Holder's Name: ❑ City ❑ Village 7M Town of: State Plan ID No.:
SIMPSON, CHRISTIAN STAR PRAIRIE
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
038 - 1132 -20 -110
TANK INFORMATION ELEVATION DAT A9700179
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark - Z. 36' /0 2.3 100-6
Dosing
Aeration Bldg. Sewer �'. ( /Op, 7
Holding St/ Ht Inlet . S 7 7 77
TANK SETBACK INFORMATION St/ Ht Outlet L ,�1 0'7.5
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic NA Dt Bottom
Dosing NA Header /Man.
Aeration NA Dist. Pipe S. Y3 Z,
Holding Bot. System 9 y7 2 •��
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand 04� Vn 3, (
Model Number GPM
TDH Lift Friction Syste I TDH Ft_
m ead
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSION
SETBACK
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of CHAMBER Model Number:
System: OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
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 Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
1AW ATION: STAR PRARIE 32.31.18.541A- 10,SW,SW 1818 WINDIND TRL RD LOT 1
af �z dd�&
&wt&bJ �a
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD -6710 (R 05/91) Date Inspector's Signature Cert. No
Parcel #: 038- 1132 -20 -115 04/19/2005 04:21 PM
PAGE 1 OF 1
Alt. Parcel #: 32.31.18.541A -15 038 - TOWN OF STAR PRAIRIE
�
Current ST. CROIX COUNTY, WISCONSIN
_
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): * = Current Owner
* SIMPSON, ROBERT W & JOY TRUST
ROBERT W & JOY TRUST SIMPSON % SIMPSON CHRISTIAN TRSTE
% SIMPSON CHRISTIAN TRSTE
543 S SHORE DR
FOREST LAKE MN 55025
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1818 WINDING TRAIL RD
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 5.650 Plat: N/A -NOT AVAILABLE
SEC 32 T31 N R1 8W PT SW SW LOT 1 CSM Block/Condo Bldg:
8/2168 EXC PT TO ST DOT HWY PROJ
1559 -08 -23 1617/26 INCLUDES P540A Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)
32 -31 N-1 8W
Notes: Parcel History:
Date Doc # Vol /Page Type
01/16/2004 751927 2493/133 QC
04/12/2001 642619 1617/26 WD
1071/212 WD
856/333 LC
2004 SUMMARY Bill M Fair Market Value: Assessed with:
30774 191,400
Valuations Last Changed: 10/15/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.650 48,300 151,600 199,900 NO
Totals for 2004:
General Property 5.650 48,300 151,600 199,900
Woodland 0.000 0 0
Totals for 2003:
General Property 5.650 21,800 111,300 133,100
Woodland 0.000 0 0
Lottery Credit Claim Count: 0 Certification Date: Batch M
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Safety and Buildings Division
vii_'■•iR SANITARY PERMIT APPLICATION Bureau of Building Water Systems
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707 -7969
• Attach complete plans (to the county copy only) for the system, on paper not less County ,
than 8 112 x 11 inches in size. G,-p
• See reverse side for instructions for completing this application State Sanitary Permit Number
4& C?3�I
The information you provide may be used by other government agency programs ❑ Check it r evision to previous application
(Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Property Owner Name Property Location
f �I/4 1/4 S 9 T , N, R/ E (042
Property w er's Mailing Ad r s Lot Number f3lo Number
Cit State / Zip de Phone Number Subdivision Name or CSM Number
II. TYPE OF BUILDING: (check one) ❑ State Owned C] C City a , Nearest Road
E] Public � 1 or 2 Family Dwelling- No. of bed rooms Town OF Ic t ,- , qee !ic/ a.
III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo b$
2 ❑ Assembly Hall 6 Medical Facility/ Nursing H e 10 ❑ Outdoor Recreational Facility
3 ❑ 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. 10 New 2 ❑ Replacement 3 ❑ Replacement of 4 ❑ Reconnection of 5 ❑ Repair of an
------ System -------- System Tank Only System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
1 1 Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
,r /��r Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) !:57 Elevation
/- 1:; Feet Feet
Cap acit y
VII. TANK in Ca gallo Total # of r Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel lass Plastic App
New Existing strutted g
Tanks Tanks
Septic Tank or Holding Tank .y f ,t ❑ 1:1 ❑ 1:1 1:1 Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ 1 ❑ 1 ❑ . ❑
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumbe ' ame: (Print) Plumb ignature: (No tamps) MP /MPRSW No.: Business Phone Number:
Plu ber' Addres (Street, City, State, Zip Code): _
...19— Grp
IX. COUNTY / DEPARTMENT USE ONLY
L E-Ad pproved Sanitary Permit Fee (Includes Groundwater ate Issue Issuing A nt Sig ature (No m Approved ner Given Initial r Surchage Fee) / erse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD -6398 (R. 05194) DISTRIBUTION: Original to county. One copy To: Safety 8 Buildings Divi ion, Owner, Plumber
PLU I PLAN
PROJECT Lr -,Sf� ADDRESS f ` 6/
1 /4 /S,Z. N /R /�W TOWN I'l COUNTY
MPRS Byron Bird Jr. 3318 DATE - o
BEDROOM CLASS PERC CONVENTIONA IN- OUND PRESS E
CONVENTI NAL LIFT MOUND_ HOLDING TANK
SEPTIC TANK SIZE TANK SIZE
DOSE TANK SIZE 10 _ HOLDING TANK SIZE
ABSORPTION AREA � �ERC RATE BED SIZE /-
1116 Benchmark V.R.P. Assume Elevation 100'
Location of Benchmark
*
H. R. P. - - - -- /�j/
0 Borehole Q Well Scale = Feet
0 Perc Hole System Elevation
Vent l
12"
TYPAR COVERING
12" 3' 4 6' 4 O 3'
I
6' Sewer Rock
i
- 12'
C
g�
�! l o
0
(k
/YB(
Wisconsin Qepartment of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page of
Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code
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 G� .
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
APPLICANT INFORMATION - Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m))AW
Property Owner Property Location
� / e f Govt. Lot 1/4 1 14,S T / ,N,R E
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
City State Zip Code Phone Number Nearest Road
C / O , `' /" . 6 6'O El city El Village R
( Town r t
J /ter � �t�r it rn T�
New Construction Use: Residential / Number of bedrooms _ Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow � gpd Recommended design loading rate bed, gpd/ft2 __ trench, gpd/f1
Absorption area required ' 3 bed, ft 2 - trench, ft 2 Maximum design loading rate _-„Z bed, gpd/tt trench, gpd/ft
Recommended infiltration surface elevation(s) a �_ �/ ft (as referred to site plan benchmark)
Additional design/site considerations // ) r
Parent material 1IX {
�—i .L _ -�Ci 5 Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In- Ground Pressure I AT -Grade System in Fill Holding Tank
U = Unsuitable for system S❑ U S❑ U lams ❑ U RS ❑ U EIS Z U ❑ s AES 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
'"
8
Ground
ele� -
tt,
Depth to
limiting
factor
_
311 Remarks:
Boring #
s ¢ / e OAR
Ground '
6epth to ,
limiting
factor
min. Remarks:
CST Na Please Print) Si re - � j Telephone No.
4a!2�'l V /` 7
Addre Date CST Number
Soil Test Plot Plan
Project Name �,,�,7i k., ,�,p B ron Bird Jr.
Address - J;��
D CSTM #3479
Lot Su division Date L ",lam
1 /4 1 /4Sd&T N /RW Township
❑ Boring Q Well PL Property Line County
BM or VRP Assume Elevation 100 ft
System Elevation *HRP
Y
� y
0 �
�p
'7
0
Scale 1/4" = 10 Ft. When Dimensions aren't stated
453053
CERTIFIED SURVEY MAP
Located in part of the SW; of the SW; and in part of the NW ! of the
SA, all in Section 32, T31N, R18W, Town of Star Prairie, St. Croix
County, Wisconsin.
OWNER E
,n
Wi Corner of Russell Fiandrick a 0
Section 32 R.R. 4 Box 192 N
L N
New Richmond, WI 54017 "
3 o c
++ o
N N U
U N
o c Unplatted Lands ° V)
g
O N _ ___ _____ __ ___ L 4-
O
-
L 3 ?
N M
L. O'
19' S89 639.28' s ° o
z
North line of the SWi of the SW} of 6`O o
Section 32 L
LOT 1 0 0 de, c .�
C O
4J 257,334 Sq. Ft.
N 5.91 Acres
o N89 °43'13 "W, 23.69' \ ��
-3 N FROM SET PIPE 639.12'
N I F
c i d N89 °43' 13 708.62' H � �pS
� i . 4, E /66/ /
�I c
a 1 o s
.0
f0 1 C M Q /
.- 1 + - \ G
C
CL I M \A
CD
W o M 4A
3z � o Small Tract
0
�1
r 30.76' a I
FROM SET P
^ 13'
N89 0 39 1 59 11 W n! �
U (recorded as N89
100.00'
Cn
N =' LEGEND /y _
°O -Lot 1
C) tD Certified Survey Map County Section Monument Found
Vol_ 5, Pg_ 1375 • 1P Rebar found OCT 3 01989► -
C1 • 1 Iron Pipe Found JAMES O'COfVNE1L 4
CD Rogisfor of DoWs
z
T SW Corner of o 1 x 24 Iron Pipe Set, weighing StCr01X
Section 32
0 1.68 lbs. per linear foot.
Existing Fenceline
S T C - 100
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner /contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
-------------------------------------------------------------------
Owner o f property
Location of property - Y)I/ 1/4 1/4, Section 3Z T2LN - R _Zg W
Township 5�A D A p P) 1� Mailing address ;I Z r , JE FF � C
Address of site
Subdivision name e 5M //W Lot no.
Other homes on property? Yes No
Previous owner of property kZS SF_ LL J., I Z4W2 i - M, �LA/IJ /Gk
Total size of property
Total size of parcel J" 91 f�CJ1C�
Date parcel was created t /D� / 98 9
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house) ? Yes No
Volume I and Page Number V�_ as recorded with the Register
of Deeds.
-------------------------------------------------------------------
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. � `/Z, - and that I (we) presently
own the proposed site for the sewage and
system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
Signature of pjlTcant Co- Applicant
q
Date of Signature Date of Signature
STC -105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER C4V -k s7°7A �l mt'3
MAILING ADDRESS 51 t = l�Yl�rt C! s� , S So13
PROPERTY ADDRESS �'fB k8 Wi t4bltO e.4 t� ��:A/D 11 ' w on
(location of septic system) Please obtain from the Planning Dept.
CITY /STATE LV (? < CA Kk o t l� U -�-
PROPERTY LOCATION,2_JV 1/4, 1/4, Section 2 T _Z/�__ N -R 28 W
TOWN OF 1 & /g T l l ie/ , ST. CROIX COUNTY, WI
SUBDIVISION CS /yl pv. �. P�. l LOT NUMBER
CERTIFIED SURVEY MAP �_cj by , VOLUME j & PAGE a�� , LOT NUMBER
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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on -site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year exp' i n date.
SIGNED: X-
DATE: ` /6 7
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
• DOCUMENT NO. WARRANTY OEEO ' —E R(SERVED FOR R'E'CORDING DATA ` 0
STATE BAR OF WISCONSIN FORM 2 -1982
514684 r ,t WIPAsE 212
Russell L. Flandrick and Georgene M.
. Flandri ck_, .husband and wife as join- ._.. _ . MAR 2 9 1994
R tenants t X .
... - -• - -- -- -- . _.
a 4. .00 P'.
.. ........... . ...... ....... -------------- I.....
conveys and warrants to . .0r1StiAn.. B.. . Simpson, ................
.... _ . _ ..... ._...................... .... -- -- - ------ ...........
YY
.... .... .... ................. • --- a
* __
'- .... ...... ............. ....... R[TU To
RM
S
w - .
.. - ---------------------------------------------- - ....._ . -. -. . - ..
. . .....- . . . . ... ...... . . . .. .... - -------- ------------- _.... ..... .
�
the following described real estate in ------ ....St. Cro1X----- -- --- - - - - -- County, 1"
State of Wisconsin:
# f
Tax Parcel No: ..............................
Lot 1 of Certified Survey Map recorded October 30, 1989, in Volume
8, at page 2168 as Document No. 453053 in Register of Deeds Office -
=; St. Croix County, Wisconsin and a non - exclusive easement for ingress
and egress shown as private roadway easement on said plat.
This deed is given y in full satisfaction of that certain `land contract
between the parties hereto dated November 10, 1989 and recorded
November 14, 1989 in Volume 856 at page 333 and 334 as Document
Number 453411.
T-7 �•
+; Li d
This - - - - - not - homestead property. rx
(is) (is not) r
Exception to warranties: municipal and zoning ordinances, easements
and restrictions of record and any lien created by act or omission `.
- of Grantee.
Dated this .... -- .. ------ -- -- -- -- day of - -- - -- – - March 94 - .............. ;9...... .
-- --- - - - - - -- - - -- -- -- ---- ---- - --- --- -(SEAL) +� �i � .._.._ _. (SEAL)
Russell L. Flandrick
.. ..... . .... . .. ..................... -- - - - -•- -- •- - - - - -- ...
R
-- --. ........... -•- - -- - ----- -- - --•- - -----.(SEAL) ly /.... .�s c _ ..(SEAL)
G rcene M. Flandrick
` .... .. ......_ ..._
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) ------------------------------ -- ---------- -- ------- --- -•• - -- STATE OF WISCONSIN
as
-------------------------------------------------
j ST. CROIX `
----------------------------- ... County. c
f
............ 19 -_ -_ -_ personally came before me this -_ O ay o
authenticated this -------- day ot_.__..._ -•_ -- _ .• �c ,y.-, .
MArOl------------ ----- -- 19_..94
•--------------------------------------------------------- •--- •---- •------ - - - - -- y
r ' ......................................................................... - - -- ....
j TITLE: MEMBER STATE BAR OF WISCONSIN • T
an_d-- wl. .................. .............
�._ ♦..�
(If not, ------------------------------------------------------------ --- --- ---- --- -•- - -- - -- --- - -- ...
authorized by ¢ 706.06, Wis. Stata.) to me known to be the person __4 ....... w �es�cu
foregoing instrument and acknowledge the satne.�
f
o
r�hA ac- 4
UTNm 8 0 B �N S a ee / f H
BEDROOM 3 Y MASTER ,rA/ S 1[ 4 a 4 " 1 " o LuO it
BEDROOM pA�L�.wwe 11Av 6�
12' ev
' -- nunlru
0
a 1111 --
0 1- --- :f4 r�
K R t`7-R ao•Nv.�
BEDROOM � LMNC ROOM I BEDROOM
No. 2 T7'•4' I IF N/DMNG ?�1,/ —pI✓6i .7 .��
r ( pq& - AIML
B213CT/4028 3BEDROOM • 2BATHS • CATHEDRAL THRU -OUT 11,050 SO.FT.) OPTION
INTEGR AIRWELL
I I
A Vl�
BEDROOM DINING ROOM ITC
i i KIffN MORNING �Tgy'�e CAB
No. J tt,8• 1 l ROOM M�C1fl_O•
10
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Na 2 1T,p Na 1 .. B U'-P
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0
OPTION
INTEGRAL FLOOR FRAME STAIRWELL
B201CT/4828 3BEDROOM - 2BATHS - CATHEDRAL THRU -OUT (1263 SO.FT.) _
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INTEGRAL FLOOR FRAME STAIRWELL
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BEDROOM p K'•B'
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INTEGRAL FLOOR FRAME STAIRWELL
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