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STC - 104 ~
AS BUILT SANITARY SYSTEM R T v
LC7
OWNER
ADDRESS
SUBDIVISION / CSM# LOT
SECTION T N-R W, Town of
ST. CROIX COUNTY, WISCONSIN
I
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
Tii
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INDICATE NORTH BROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK:
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity: /per
Setback from: Well House Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: 51 Length 10d Number of trenches 2
Distance & Direction to nearest prop. line: lJo-T~;r-
Setback from: well:l~l/ pl- House Idar= Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER: yy/ ~~'7
INSPECTOR:
3/93:jt
Wisconsin, Dephrtmentof Industry, PRIVATE SEWAGE SYSTEM county:
atand Hmldi Relations
Safety and Buildings Division INSPECTION REPORT ST. CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State P94:19
SCHNABL, TERRY X
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
*9400199
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic V V 7 Benchmark boa, 3
Dosi ng 106,Y
Aeration Bldg. Sewer
Holding St/ Ht Inlet ggff.2-
TANK SETBACK INFORMATION St/ Ht Outlet 7,gti ~g
Vent
TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet
Air
Septic -30" >-30 ' NA Dt Bottom
Dosing NA Header/Man. 71 y6
Aeration NA Dist. Pipe S d 7. S"
Holding Bot. System
qG ~6
PUMP /SIPHON INFORMATIO Final Grade
Manufacturer Demand ~r
Model Number GPM
TDH Lift Fri bon System TDH Ft
mead
Forcemain Len th Dia. Dist. To Well
SOIL ABSOR TION SYSTEM
BED/TRENCH Width I Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ~6 U DIMENSIONS
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK CHAMBER Moe Number:
INFORMATION ypem Jar )Tl(~D ~Dd' /0D OR UNIT
System:
S )'7~.~t,~,f=
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 Iscrepanoes,persons present, etc.) 3
LOCATION: Hammond.30 29.17 , NE, SE, 160th Street 7e~
'7 s
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. 4 y
SBD-6710 (R 05/91) Date Inspector's Signature Cert No.
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ADDITIONAL COMMENTS AND SKETCH
A
SANITARY PERMIT NUMBER:
E
EZ'R SANITARY PERMIT APPLICATION co
In accord with ILHR 83.05, Wis. Adm. Code CIIX
~,~...R
STATE SA ITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑ U'sq ~1--
8% X 11 inches in size. Check if revision to ddOevious application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
/ ' t/4,5,r- '/4, S T;t , N, R 12 E (Or)
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
,-4 7-,e.11
STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
sQ 2 T7 -O 41a a 4
11. TYPE OF BUILDING: (Check one) El State Owned 0 VILLAGE NEAREST ROAD
4
A44a~ -A z 19 404W W:
❑ Public k41 or 2 Fam. Dwelling-# of bedrooms PARCEL TAX NUMBER(S)
III. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apt/Condo v
2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 80 Mobile Home Park 120 Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit - 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 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 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. SYST M ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
l'Qa ® .r % Feet !Q?.r Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank e PQ I F] 1-1
_X~ (I Lift Pump Tank/Siphon Chamber
1-1 F1 I F
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system show on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No Stamps) PRSW No.: Business Phone Number:
Plumber's Address (Street, City , Stat , Zip Code):
l o „~C d (~i /v r V^ O
i
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date ssue Issuing Agent Signature o Stamps)
Approved El Owner Given Initial Surcharge Fee) 160
ey I Adverse Determination X X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
* s
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at the 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 'SED 6399) to be
submitted to the county prior to installation.
5. Onsite sewage systems must be properly -maintaiined. The septic tank(s) must be pumped by a licensed
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 & Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. 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 in 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 in ##1-7.
VII. Tank information. Fill in the capacity of every new and/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% 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 mainsoo/ater 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, ground-
water contamination investigations and establishment of standards.
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SBD-6398 (R.11/88)
'Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3
Labor and Human helations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. A Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. P include, but ST. C ?-O lX
not limited to vertical and horizontal reference point (BM), direction and % sc~~ EL I.D. #
dimensioned, north arrow, and location and distance to nearest road. sv
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATI R DBY DATE
PROPERTY OWNER: ffOPEV LOCATION ;
-T-)EZVLLr SQ-tk fV P,$L 1JQj 1/4 SE •1 0T N,R l]l E(o )
PROPERTY OWNER':S MAILING ADDRESS EDT'#,, BLOCK # SUED. NA~KOR CSM #
g4 ~3 ZZ~ ST, tJ . - -
CITY, STATE ZIP CODE PHONE NUMBER []CITY,. `[]VILLAGE WOWN NEAREST ROAD
L V-z tsL.l~Ot MjV SSogz (61Z)7-) 3 o14 ZS )60 `M ST
New Construction Use [ Residential / Number of bedrooms Z [ ] AddiWn to existing building
j j Replacement [ ] Public or commercial describe
Code derived daily flow oo gpd Recommended design loading rate - bed, gpl:W 0. 3 . trench, gpdV
Absorption area required - bed, 1`12 to ov trench, ft2 Maximum design loading rate - bed, gAV o .S trench, gpd1ft2
Recommended infiltration surface elevation(s) s e-t PhaE 3 ft (as referred to site plan benchmWnr s` yTlH DFV-17N~
Additional design / site considerations SSDF >JUTQ OAJ 1P- >'1.6t_ z .
Parent material s (mtY1syr auez S W Gt- Flood plain elevation, If applicable M.N. ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for stem ® S [I U ® S ❑ U EaS ❑ U s0 U S I~..U ❑ S RU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure ConsislIertce Bourifty Roots GPD/ft
in. Munsell Qu. Sz. Conn Color Gr. Sz. Sh. Bed f~tctt
o-L 0 ~oL,\Z-31z - si z s~k vn~~ ek, Zug o.s o-b
Z tioz~ 10~~ 316 - s111 Z~S~k cw 1uf o s o~6
Ground 3 z lj 3Y 10`12 yjf: - S I l S bk hA vj OS o• ~I u. S
elev.
gq_zft. 3 ~OKRSJ~ - S O S5 o•~ v.8
Depth to
limiting
facto
Remarks:
Boring #
vY 0- R 1 o `'1 ~Z 31 z - s I Z fsS k yh z u~ o• S o. b
z
Z g-iS 10tiR 3~G St 1 2- fSbk OI.V o.S o.b
g
3 ZS-Vb 7.Sy►Z3/Y _ s I 1~sbk cs o.~{o.S
Ground
elev. 4 6 1 C~ y R S /C S F S b S v+~ 1 o. S` o.
oq.Lft.
Depth to
limiting
factor
?
-)y Remarks:
TName:-Please Print Phone:
Vdress: Arthur L. We erer 715-425-0165
egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Sgnature: Date: CST Number:
6-6-9}~ M00576
PROPERTY OWNER So-N)jf~8L SOIL DESCRIPTION REPORT Page Qf
it
PARCEL IA
Depth Dominant Color Mottles Texture Structure Consistence Bounclaly Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
•^C'` ~ 0-8 1o`'lR- 3 lZ ~ sLl 2`FSbk ~"'ti CS 2v~ 0.5 0.~
Z g-Z-8 twt Z- 31e s t l Z`FSbh >n aki \v~ o•S 6
- o•y os
Ground 3 Zb'-33 10`tI Z- V/L S ` ` esbk mvf~ 0-S
elev
a~.$ ft. 33-67. lb 112 VA. ~ S ~Z 31 to ~ C S o•l U.$
o►►~ rn v - c.~ b.S
Depth to LO`1tZS1(,
limiting
factor ~ih f hl S ~u o f owt s i
Remarks:
Boring #
0-B ~O`l~Z jl2 SL~ Z`~~1z wL'~1 CS ZU1 o.S 0-6
Z $-2~ 1~"l2 31b S~1 Z`~3bk wcCS Fv~ o,s o.6
3 1438 1oL.1zu16 - S~ Z?--A c )nu L. Cs _ o.vIrs.S
Ground
elev. y 3$-7`- 10-IM Sf e.S n, 6
`fib-6 ft
t~[)A17 A/ S u &ut-r5 O Yri ~k 3) o L s
Depth to
limiting
factor
7L4 "
Remarks:
Boring # _ ~{/Q 1h p b
s t;,{cx.• , O-$ Lb Vl CL'3IZ S11 1 JL12 ,'"L'~h CS ZV C ~•S
1o-1t?- '31L Sl ` -Li3bk ivLj~- C i,.- X uj O•S n. L
dd S 1
Sp
3 z.~f -3o to ~-Y~L - S ~ ~ e Sb~C ~ v `F c s _ o , ~ o • S
Ground
elev. 3 e_ 6y 0`1 R S i 6 _ S D g 9 yn C S - o. -1 q.
q$,Dft.
S brF-7n Vb4L S/3 C Z. x Vl. uiv _
Depth to
limiting
factor
Remarks:
Boring # ,
MI-11M. 41 0-9 Lv`~~L3lZ - 3~~ Z`~gbk 1,i GS ZV1 o.S v•6
Z q -ILL t o `tibZ ~ 16 S C I Z `F 3 bk jn `F~, c S 1 v~ o. S~. 6
EMU
3 Z`-7b lb~[2 Y/~ - S b Sg - 0,1 o, 9
Ground
elev.
99-0 ft. eou nJ S 1N IRE ki S \Z~ 0-5 01= 3 ` S h 1? S l
Depth to OF o• GPI Q S O L
limiting _T'Q) W L S 1 1 UQ G
factor
Remarks:
SBD-8330(8.05/92)
e F s r s 5 Tw 1 ow,~ d
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER TERRY D SCHNABL and SHERYL L SCHNABL
MAILING ADDRESS 8483 27th NORTH LAKE ELMO MN 55042
PROPERTY ADDRESS 740 160th STREET HAMMOND WI 54015
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE HAMMOND WISCONSIN
PROPERTY LOCATION NE 1/4, SE 1/4, Section 30 , T 29 N-R 17 W
TOWN OF HAMMOND ST. CROIX COUNTY, WI
SUBDIVISION NONE LOT NUMBER NONE
CERTIFIED SURVEY MAP , VOLUME , PAGE , 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 expiration date.
SIGNED: <
DATE: (g ' z 3 - ,'2 ~z
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
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 of property TERRY D. SCHNABL and SHERYL L. SCHNABL
Location of property NE 1/4 SE 1/4, Section 30 , T 29 N-R 17 W
Township HAMMOND Mailing address H- 1k=10 TOWN CLERK
4TTN. MARCIA IVEY 1993 COUNTY ROAD J, BALDWIN WI. 54002
Address of site 740 160th STREET HAMMOND 54015
Subdivision name N9NE Lot no.
Other homes on property? Yes XX No
Previous owner of property MOLT EN FARMS. INC.
Total size of property 40 ACRES
Total size of parcel 40 ACRES
Date parcel was created
Are all corners and lot lines identifiable? XX Yes No
Is this property being developed for (spec house) ? Yes XX No
Volume 06 2 and Page Number (2 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. _ LJ°f" _3?Z , and that I (we) presently
own the proposed site for the sewage disposal 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.
Signatu Applicant Co-Applicant
3 - 5pp i'
Date of Signature Date of Signature
a
.*t7G97 'VOL 1Q82 186
PAGE F„ 1S71G23'f`a,
Read t4r l~seoM y
JUN 1 0 19i
i
p;
e'C "Wav'f
ARRANTY DEED
W
(WISCONSIN) L , wdr , ' 'r
MOLTZEN FARMS, INC. Grantor, of
CLARK County, WISCONSIN CONVEY and WARRANT to
TERRY D. SCHNABL and SHERYL L. SCHNABL, Joint Tenants
ST. CROIX County,
Wisconsin, for the sum of
THIRTY-FIVE THOUSAND FIVE HUNDRED AND NO/100-----------dollars
($35,500.00 the following tract of land in ST. CROIX County,
Wisconsin,towit: Northeast Quarter of the Southeast Quarter (NE'k-SE'k) of
Section Thirty (30), Township 29 North, Range 17 West.
Zbgether with easements, restrictions and rights-of-way of record, if any.
r
Witness the hand and seal of said Grantor this 3rd day of
June ,19 94 .
In the presence of:
MOLTZEN FARMS, INC., (SEAL)
PRESIDENT
MOLTZEN FARMS, ~'Lvf . ; SECRETARY-Tim NJRER~
(SEAL) I
(SEAL.)
ACKNOWLEDGMENT
NNNUIM~•.
STATE OF WI$~9IN^, s•..•,
COUNTY OF C~i`1R.•'" fa'h
Personally cri brfn rt#is~ • _ 3rd day of June ,1994 ,the above
(or within) name t:r ;Multi Vil d Ida G. Mo l t z e n
• r ` to me known to be the persons who executed the foregoing (or within)
instrument and ackno e, the same; • fi
My commission expires:
Notary Public
Cnuntv. Wisconsin
y,
WARRANTY DEED
(WISCONSIN)
MOLTZEN FARMS, INC. Grantor, of
CLARK County, WISCONSIN CONVEY and WARRANT to
TERRY D. SCHNABL and SHERYL L. SCHNABL, Joint Tenants
ST. CROIX County,
Wisconsin..or the sum of THIRTY-FIVE THOUSAND FIVE HUNDRED AND NO/100------------ Dollars
(S35,5500-00 I, the followine tract of land in ST. CROIX County.
J -
Wisconsin, to wit: Northeast Quarter of the Southeast Quarter (NE4-SE 4) of
Section Thirty (30), Township 29 North, Range 17 West.
'Ibgether with easements, restrictions and rights-of-way of record, if any.
Witness the hand and seal of said Grantor this 3 rd day of
June , 19 94.
In the presence of:
* MOLTZEN FARMS, INC., PRE SID (SEAL)
ENT
* * MOLTZEN FARMS, 1 . , ATfY-'I'KEAS'URE
* * (SEAL)
* (SEAL)
ACKNOWLEDGMENT
STATE OF WISCONSIN )
COUNTY OF CLARK )
Personally came before me this 3rd day of June 1994 , the above
(orwithin)named Mark H. Moltzen and Ida G. Moltzen
to me known to be the persons who executed the foregoing (or within)
instrument and acknowledged the same.
/7
i
My commission expires:
Notary Public
(-olf,7t ~11rc nncin
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
1 NOR u r u■ ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016-7710
` (715) 386-4680
August 1, 1994
Terry Schnabl
740 140th Street
Hammond, WI 54016
Dear Mr. Schnabl:
This letter is to confirm that a sanitary permit has been issued
for the property located at the NE,, SE'„ Section 30, T29N-R17W,
Town of Hammond, St. Croix County, Wisconsin.
Permit #218914 was issued in your name, to William Schumaker,
MP6382, on June 29, 1994 for a conventional septic system. As of
this writing, the system has not been installed.
Should you have any questions, please contact me.
Sincerely
cAa~e'tlj
Mary Assistant Zoning Administrator
cc: Clerk, Town of Hammond
File
PLOT PLAN Page 3 of 3
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(715 F -1. L
) 42.q-0169 M00576
CST Signature Date Signed Telephone No. CST #
isconsl Deparfinentof Commerce PRIVATE SEWAGE SYSTEM County:
eyand Bumps Division St. Croix
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal irdormation you provice may be used for secondary purposes (Privacy law, s.1 s.04 (t)(m)). 384149
Permit Holder's Name: p Crty p Village ❑ own o : State Plan ID _1
ermain M & G), Mike Somerset Township
ST BM E ev.:. Insp. BM E ev.: BM Descriptio ,xt ::n(~ Parce Tax No.:
t7D •c71 m #O _ 2e 'CS el"` ( 032-2114-60-000
TANK INFORMATION ELEVATION DATA 3z -3l. : SID Sy
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 16D-D Benchmark 7y Z Co . a r
Dosing Alt. BM
Aeration Bldg. Sewer
.y
Holding St/ Ht Inlet 9- 3o Z• S*
TANK SETBACK INFORMATION St/Ht Outlet .SS 92.33r
TANKTO P/L WELL BLDG. Ven
Air ttake ROAD Ot Inlet
Septic 3S -F' ~0 3 r 2(o r NA Dt Bottom
Dosing NA Header/ Man. jo. o ql 80 r
o.ol
Aeration NA Dist. Pipe D. o q/, 83
Holdi Bot. System
MP /SIPHON INFORMATION Final Grades 0 9 Pr
Ma ufacturer nd St cover 3.3 S 98.3-3 r
Model ber GPM
oFemain Li riction System TDH
ead
Length Fi ell
i. `~.2eR mss.
SOIL ABSORPTION SYSTEM Q~ 2 • l S
IFG$/ Width Length No Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS c DIMENSIONS
Sje
SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING EM
ATION A /
INFORMATION Type O r / r CHAMBER a N(um r:
INFORM
System: 2.0~-o ~3 OR UNIT - u
DISTRIBUTION SYSTEM
Header/ otd Distribution Pipe(s) cing Vent To Air Intake
Leng~ Dia. 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.)
Inspection #1: 0(o /2(/01 Inspection #
Location: 2351 53rd Street, Somerset, WI 54025 (NW 1/4 SW 1/4 3 T31N R1 9W) - 0331191054
Meadowoods -Lot 6 ~
1.) Alt BM Description =To? 2.) Bldg sewer length= al. -amount of cover $W"
Plan revision required? ❑ Yes N No
Use of he rrsside for dditional information. O~ 124
D, D (RV71' C"` ~j Date Inspector's Signature Cert. No.
L
7751, S 3 5 . Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.21. Wis. Adm. Code 201 W Washington PO Box Ave.
N*6c;qnsin See reverse side for instructions for completing this application 7302
Personal information you provide may be used for secondan, purposes Madison. WI 53707-730,
Department of Commerce (Submit completed form to county if r
[Privacy Lay,, s. 15.04(1)(m)J state owner
Attach complete plans (to the county co only) for the system. on paper not less than 8-1/2 x 11 inches in size.
County State San tary Permit Number ❑ Check if revision to previous application State Plan 1. D. Number
c U 1 38
I. Application Information - Please Print all Information Location:
Property Owner Name Property Location REma C1A _jW1/4, S T 3 N, R or
Property Owner's Mailing Address Lot Number Block Number
City, State Zip Code hone NuSdreeplOj Subdivision Name or CSM Number
` Jr ZONICOUNTY ~R ! W00/JS
II Type of Building: (check one) ❑ City
I or 2 Family Dwelling - No. of Bedrooms: T--~ ❑ Village
1 ` 3 S ~ tp (tQo,nb 1 C~ 1^ \ y VTown of
❑ Public/Commercial (describe use):
❑ State-owned
III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road 5JAI), .57,
A) 1. )0 New System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s)
System Tank Only Existing System 3' /
B) Permit Number Date Issued
1 ❑ A Sanitary Permit was previously issued 1 103.3 1,7
IV. Type of POWT System: (Check all that apply) 4 T ` I rao
00 Non-pressurized In-ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At-grade , 1 ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
a 3 93.1-5' C &S
V Dis ersaL/Treatment Area Information:
1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (Gals./day/sq. ft.) (Min./inch) 9p, Elevation
A-7u2kt , 93-s
O o 5-000 88- y 9 s- 3
VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
❑
/ C~ U Mr ❑ ❑ 11
❑ ❑ ❑ ❑ ❑
VII Responsibility Statement
I the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (print) Plum r Signature (no stamps): /MPRS No. Business Phone Number
0'a" OW (SCoV1y IT 7- 16~ -GGs /
Plumber's Address (Street, City, State, Zip Code)
5G OALLA--
VIII County/Departm nt Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Iss ing Agent Signature (No stamps)
Approved ❑ Owner Given Initial Adverse Sur arge Fee)
Determination ZT, 2,00 [
IX. Conditions of Approval /Reasons for Disapprova
-XF -t{ S ,-5 co o- s s k 3 ' ~ed~.> t ~a aae
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"visc )epart(nent of Commerce SOIL AND SITE' EVALUATION
Dlaig of Safety and Buildings Page 1 of 3
Bureau of Integrated Services in accordance with s. ILHF3.BU9, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in si PnTnust unty
include, but not limited to: vertical and horizontal reference point (BM ite on nd St. Croix
percent slope, scale or dimensions, north arrow, and location and di Aco(to nearest)ogj ParceP,LD. #
r
APPLICANT INFORMATION - Please print all in a> n ~r O Reviews Date
Personal information you provide may be used for secondary purposes (Privacit:ai ''s. 15.04 (f)T4y":;, f C~
Property Owner Em" @r1
Richard Stout govt. Lot NE . 1J;uw 1/4,S3 T 33 N,Rl 9 E (or) XJ
Property Owner's Mailing Address L'o~ `,B"t, r ubd. Name or CSM#
Meadowoods
1353 Awatukee Trail
-6 t city State Zip Code Phone Number [:1 City El Village )E] Town Nearest Road
Hudson Wi 54016, (715)549-6731 Somerset 232nd Ave
® New Construction Use: Residential / Number of bedrooms 4 Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow 6 0 0 gpd Recommended design loading rate 5 bed, gpd/ft2_6--trench, gpd/f12
Absorption area required q200 bed, ft24.g("e trench, ft2 Maximum design loading rates gibed, gpd/ft2--6-trench, gpd/ft2
(as referred to site plan benchmark)
Recommended infiltration surface elevation(s) See p1 et p1 ft
Additional design/site considerations
Parent material Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U = Unsuitable for system ®S ❑ U Us ❑ U Eks ❑ U IFKI S ❑ U ❑ S ® U ❑ S O U
SOIL DESCRIPTION REPORT 11 1
-01 h_
Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 ~
g Texture Consistence Boundary Roots
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 .2. .3 .2
1 -12 10 r4 3 it ms~a
2 12-2 10yr4/6 icl 2 M5.~ le mfi cs
Ground 3 4-8 10yr4/4 1 a mfr cs .5 ..6 S
elev.
96 .4 Oft.
Depth to
limiting
factor
8 9 in.
Remarks:
Boring # 3 2
K35-1 )-10 1 Oyr4/3 _-L XS
2 0-5 1 Oyr4/6 icl 2 JS k-Al mf i cs .4
5
0 10yr4/4 1 MS' mfr cs S
Ground
elev.
9 3-1Qft.
Depth to
limiting
factor
110 in. Remarks:
CST Name (Please Print)I Signa a Telephone No.
C
Address Date CST Number
r ( z / y 5 3 3 Q
r'0 7G SC.4 ~2 , -q C
Richard Stout SOIL DESCRIPTION REPORT }
PROPERTY OWNER Page 2 _
PARCEL I.D.#
# Horizon Depth Dominant Color Mottles Structure
Boring Texture Consistence Boundary Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench
3 1 0-11 10 r4 3 •Z -Sil 2 1 1- 5 1 0yr4/6 sicl 2)Ay'b mf i cs .4 ' . 5
Ground 3 25-90 10yr4/4 sl 7~5~jL( mfr cs .5 ,.6
elev.
9 5 _D-ft•
Depth to
r '
limiting 9D . S
factor
9 0 in. S`f o
Remarks:
Boring #
. Z
1 -10 10 r4 3 mfr If .'5
2 0-5 1 0yr4/6 icl
4 2 s'b K mfi cs .4 •
3
0-9 10yr4/4 1 ` mfr cs .5 :6
Ground
elev.
96.10 ft.
Depth to
limiting
factor
$4-in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring # 1 -g 10 r4 3 156 k- mfr r-.q ]f
Z
2 -58 10 r4 6 icl •`f
3 58-1101 10yr4/4 1 ~x{a mfr cs 'S~
_9 _6
Ground
93. Lelev.
O ft. 458.4o r
~r
8.8 w8e'
Depth to
limiting
factor
1$1-in. Remarks:
Boring #
Ground
elev.
tt. ,
Depth to
limiting
factor
in. Remarks:
SBD-8330 (R. 07/96)
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Private Onsite Wastewater Treatment System Management Plan
Septic Tank And Gravity In-Ground Soil Absorption Component
Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment
System (POWTS) shall include information and procedures for maintaining the system within
the parameters of Comm 83 and 84, and the conditions of approval by the department, agent,
or governmental unit. The approved plans and permits for system are on file at the county
zoning or health department.
This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground
Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-
10567-P (R.6/99).
Table 1: System Design Specifications
Sanitary Permit Number I It'i
Number of Bedrooms
Design Flow - Peak (gpd) S_~O
Estimated Flow - Average (gpd) t7 i)
Septic Tank Capacity (gal) t7IIn
Soil Absorption Component Size (ft2) 2 <
Type of Wastewater Do stic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd) Lrt Z - `n O_& ne't
Maximum Influent Particle Size (in) 1/8
Maximum BOD5 (mg/L) 220
Maximum TSS (mg/L) 150
Table 3: Maintenance Schedule
Septic Tank Inspect and/or service once every 3 years
Outlet Filter Inspect once a year and clean at least once every 3 years
Soil Absorption Component Inspect once every 3 years
Septic Tank -
The septic tank shall be maintained by an individual certified to service septic tanks
under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with
NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease
Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable
Restrooms).
The operating condition of the septic tank and outlet filter shall be assessed at least
once every 3 years by inspection. The outlet filte shall be cleaned as necessary to ensure
proper operation. The filter cartridge should not be removed unless provisions are made to
retain slids in the tank that may slough off the filter when removed from its enclosure. If the
Management Plan for a Septic Tank and Soil Absorption Component
.l
Plantings of deep-rooted trees and shrubs directly over or within ten feet of the
component should be avoided since root intrusion into the component may obstruct wastewater
flow.
I'
3
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner[Buyer Mt G- T14 G h-N _ C, tr ►r~ rte
Mailing Address 13!~'wt>J 1,r Fg,
Property Address 2.3 S I 0 zg v'
(Verification required from Planning Department for new construction)
City/State S -v---CT Parcel Identification Number 02> ~III-l(n0.00t
03,31.1~,1~s~
LEGAL DESCRIPTION
Property Location Sec. T3 ) (4R 101 W Town of Om~ KSET
T(~ ItJ 7Q S , ~ u
U
Certified Survey Map # , Volume , Page #
Warranty Deed # (~s ~C (o Volume t~52 Page i;
Spec house,, yes ❑ 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 syster
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
masterplumber, joumcyman 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. ~J
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
1 (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) ant (are) the owner(s) o
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: 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
02/19/01 'NON 16;04 FAX 715 .386 4687 REGISTER OF DEED, 1001
I STATE BAR OF WISCONSIN FORM 2 - 1998 i+ 6, 85[]9
WARRANTY DEED KATHLEEN H. WALSH
I. 1 ? t~ I~ ST. REGISTER OF DEEDS
Document Number
r.. - pAG
- RECEIVED FOR RECORD
This Deed, made between
RTC'RARn 0 - STO.UT and .7AXFm p - Z.1'O IT ~r ~ 02-19-2001 4:00 PH
--husband and.. w ' f RT WARRANTY DEED
_ Granto, EXEMPT 1
_ CERT COPY FEE-
and INC _
COPY " T5l:ER:
FEE: 126.90
_ RECORDING FEE: 10.00
II Gnc h PAGES: 1
Grantee.
i' ntor, for a valuable cccmideraticn, conveys and warrants to Grantee the following
described real estate in ...,.~St _ Croix Couniy, State of wiiermsin
of , Plat of Meadowoods, Town of Somerset
St. Croix County, Wisconsin, Na ar:J RSiurr. Address
it ~l 035 fat`~A~Tir.kLO T-
q H
Sy 4; i LP
i
If
II
Parcel l~:erti ation Number ;PIN)
This_ i- nOthomestead property
' is . or)
I,
i~
Ii
i
ri
r
i
+i
Exceptions to warranties, ea..ements, restrictions, rights-of-wdy and Cc.venants
of record.
Dated this 16 t h day of - Flebri1ar3 2001
~I
rc~ I \ II
;SEAL} GLr rZ' '`s.. _ (SEAL)
Richard O. Stout Janet P. Stout
'SEAL) (51r:11.)
~I
I
AUTHENTICATION ACKNOWLEDGM ENT
Stgnature(s} _ _
State of Wisconsin,
55 ~
St. Croix Cc ,sly.
authenticated this day of Personally came before me this
~.1 day of '
Februar;r , the 3nve named
R~ ch, r-d.,..0. ati4--.Zr' zet i;
S.ticult
77.
to
TITLE ivIEMBLR' S> ATE BAR OFr[SCONSiN
me known to be the error,
(Tf not. person -5 whD executed tit ri
$ !
authorized by.§'06-06" Wm Sfats') insffti rient and acknowIedKi the same: ii
i & Piota r r'ublic:
THIS INSTRUMENT WAS DRAFTED EY { s a
Janet P. Stout
~I
1353 Aw.atukes Tr.
_
Hudson, W1 5401 6 Notary Public, St.a' . of Wisro si.~
My commission s permanent. {7f not, stat expi, tion dare; j
(Signatures may be authenticated or ask ,cwtecge Both are not
necessary.}
_
,i
• Namur. of por ms ogning in any capacity must tk i~- A prides mow thc!r ; Ig'natuio,
STATE BAR OF WISCONSIN w...~,yr• , ~L ;a Sank Co.,
WARRANTY DEED FORM Nn. 2 - 1998 ti waulma, W ,
M E A D 0 W 0 0 D S
C evs S' 3, T,31 01
3 •
PCn
N8896'15•E 529,.22' see+a'1:•+f I 2842_ 8' _
N88105`E 1326.17'
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a sese+ so, r' s-. : e x~'- i •e 5a m
3.18 ACRES 5-66 7 233C0~'938 %9. S09
6..7 9 ---2T}01•1 •8r tb t8.• 2"4
_O..ERaI_- 27 .300 -95.St SI
8-9 '0 '6- -.-j 1198- 7338- 510-NW
Ina ,.e6'I6 i 34 E 628 37
b 3EGM
rc.^tr Sect,cr Corner Monument of Record
t Set `..'6' . 3C•• Sad Round 9w
N 46 coo•as 0a '.rear foot
vt
o ~ M' ot••r r co••,ers are rnfwysffr•tW 111itn
' n 7 a
At ~ L . 24' PP* etignNq 1.6e Round
• !33.962 So. R. •nea 'oo•
3.06 ACRES O n_ •w Poe
lJ' a / •.•...8. c^q Setocc..ne: 100' i'aw RigllE-N
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N83.49.' 2'E o
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.'•a•r - -=e-Ssc Easement
SEMM MARKS,
OD in E_EVAtI•F.S . a.. <SS:.vED DATUM.
•65.588 SO-
3 80 n
a ACRES Y gyp'
d n O AL Mr AS' RE•.E'•'i -,E ifE N MADE TO THE "EARM
ti 'A OF A •s-, A_: a•.S-401 VEASt:RENENTS MERE MADE
CO 3 ✓ ct (5) SECExr05 +•:0 'Cap-'•EL• TO THE vALUES SWMI
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R88'IE'C+-[ 73° 1'3• f•CH P oR.:r_ 5.•9Ar. s : '-S VAP IS SuS.EC*- TO REGULATIONS ST
• TOTR:rc aAS. R-: ES (•.f. eIE Etl
P _ aCCESS •0 °-~_E `-"r). dE°ORE PURCHASING OR
L~~ 8 0 .R, t_ I. c..RI ..Cc•.. ZOter:O OETICE AND
9O
'^`S- U1 IA
.~N68'16'OI'E 3957;• - 9 • 'EMPORAR• _ Ea:rvE%T •S TO K REMO
13G.73E
S.OO aCPES a
s - POt~ E~MEwT RFSTR~t -3NS,
c ~ ~ _ •:7 r.RAD-%Z :vi ••.5'i; Jr, oER>ATTEO IMTHIN THEM
n
J+ r
150.73 O50 ~RFA OF PII.T:
46.5,9 '•3
3.00 ACRES 40.39 ACW5
~••r AREA TAO' BE DEDICATED 70 THE PUBLIQ
)5.063 SO
r
2,8 aC4E5
N8816.01-E 472.95* /t I 11 2
o 1i7 1411 '17 SO
s nn .r w.: u t
N A
130.729 50. FT .n _ n
P01fD
3.00 ACRES 'a " . , ^i e• 110.. SY
♦ i A'' 111•
.e ° ~r6M~ c, re `y ,
- a
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• MARK:
• Pf_v., . r L BENCTi a t
f.", Sa 'Ay
-46A ta... _ - - - ' - _ s. f . - .;,4 •r 2.,;•. ~r - AA♦
2.32ND AV-NU <rE _.E. w
r
PLAT OF MEADOWS S
-u,-} -NORTH 114 CORNER
(COUNTY PLAT)
SEC. J-31-19
Quarter of the Southwest Quarter of Section 3, T'~! (FND MASONRY NAIL,
Town of Somerset, St. Croix County, Wisconsin.
N
991.7
f x 1 ; *HARO
s 992.9 v -
AJV6O
EeR~P6~
dSIN x ~ iC ^
'0 980.8 c,5~' I I
ND N0. 4:6.9 0 25 987.1
1 _ - =98
THy3~t' 1~4 HWL s X .
S8
ION
--5-..ZZ'------------
S 6.17' X 086 q 'N 2U. C_ ' 4
- 627 x
89.0
TEMOORARY r
CUL-DE-SAC__ ' 85'
X 1
EAS~MEN - 989.5 X
9a 990.9
3 ~ Y 133,654 DSO. FT.
C 3.07 ACRES
X5 _ X 993.0
989.1 990.4
X 993.1 X 991.5
X -
62$' / - 995.0 r
995.0 X
989.8
~~yo 997.5
% :133.962 SO. TT X 996.5 _
7 I 3.08 ACRES' 1002.8 I i I
X
1 - 4
- ' I !
' I( 1001.1 n
X
,
Y~ 1 64Y a
4 1002-8
/ _