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HomeMy WebLinkAbout026-1294-36-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 567294 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: Richmond Acres LLC, c/o Gerald J. Smith I Richmond, Town of 026-1294-36-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: T� 8 1 �T 28.30.18.1518 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION / BS HI I FS ELEV. Septic Benchmark"6"' �o r -3 ,-7 14?•7 7 l _ Alt. BM Aeration Bldg.Sewer y ,/ gS 3 Holding St/Ht Inlet S,St/Ht Outlet 7 97.1 7 TANK SETBACK INFORMATION �' 9G •F TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ Septic 39 �� 5 7 /&6 f Dt Bottom t Dosing Header/Man. 9.7 3 Aeration Dist. Pipe /6. 0 17 •7 Holding Bot.System /6.7 TZ Final Grade �.� q�� PUMPISIPHON INFORMATION lI Manufacturer Demand St Cover GPM �/ J 2 .7 /&Z..7 Z--7 14n },n C� Model Number TD H Lifts Friction Loss System Head TDH Ft Forcemain Dist.to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS ? 1 7 `G� �--- �- -� SETBACK SYSTEM TO P/L _-BLDG WELL LAKE/STREAM LEACHING Manufactur,,,-. INFORMATION CHAMBER OR Typ6System:J4 Z� �� 16 �� UNIT Model Nu76,L'. DISTRIBUTION SYSTEM Z3 +-7-13 = 4Gr Header/Manifold Distribution x Hole Size x Hole Spacing V Air Intake Pipe(s) \ ` ��� j� Length_Dia 11+ Length �ia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over I Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center N Bedrrrench Edges` Topsoil '**' ye s 0 No L Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / 17/ / Inspection#2: Location: 1144 132nd Ave New Richmond,WI 54017(NW 1/4 SW 1/4 28 T30N R1 8W) Richmond Acres Lott 3,(6�.. Parcel No: 28.30.18.1518 1.)Alt BM Description= • ' �`��� a �" '( 2.)Bldg sewer length= /1. �I �D -amount of cover 1 Plan revision Required? 0 Yes o 4 Use other side for additional information. L _ J Date Insepctor's Si nature Cert.No. SBD-6710(R.3/97) PLOT PLAN PROJECT Gerald Smith ADDRESS 11160 190th Ave NW Elk River Mn 55330 NW 1/4 SW 1/4S 28 /T 30 N/R 18 W TOWN Richmond COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 12/12/13 BEDROOM 3 CONVENTIONAL )00( IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 931 # of chambers 46 IL BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O,1 WELL *H.R.P. Same as Benchmark Scale is 1" = 4O' SYSTEM ELEVATION 92.0/92.1 7' below qrade unless otherwise All piping shall be SDR 30/34,within 10' noted Vent of tank,piping shall be Schedule 40. >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 100' 5.6ft^2/pair of end caps 4' Long 12" Grade at Sy tem Elevation 99' 34" B-2 40' 4% Slop 30' T� B-3 2-3' 94' cells with>3' s cing 'S B-1 80' ( � 20' B.M.* ST 15' 140' IF � Pro 3 Bedroom House �2 132nd Ave ,40isiiiiiss. County 1 ii ir Industry Services Division �7( (D/p , `. 1400 E Washington Ave Sanitary Permit Number(to be filled in by Co.) rl P.O. Box 7162,; ` .1 �72-74 Madison,WI 53707-71% • itary Permit Application ,y State Transaction/Nuummber In accordant `w SP -• .21(2),Wis.Adm.Code,submission of this form to the appt'oplate goverh-Ke)ltfI unit is required pri. .obtaining a sanitary permit. Note:Application forms for state-owned PS are sutrtaftted to Project Address(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may . _t 4 or secondary purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stets. ■ . 4- /W 3 2 n i I. A i i lication information—Please Print All Information MIiI. ` / "I-�(' h Property Owner's Name V"' III Parcel# (e J 1 l l / f ' L ' � t� or - -- /aP- — • —IF/am Property Owner's Mailing Address Property Location /1 I .b�� I Po 't N� �Govt.Lot ( I1 City,State yy� Zip Code Phone Number /bw y.,Sc,..) /, Section Z� /( ?�t).& / I 1 r� / (�hcle oq l 3 v r-T Jp -N; R 1 U Eor W/1 II.Type of Building(check all that appl Lot# Subdivisionnna `�Lor 2 Family Dwelling-Number of Bedro ms� �� �j� /[�6� (�k 1 a, Block ❑Public/Commercial-Describe Use ❑City of• ❑State Owned-Describe Use II CSM Number ❑Village of t 13 �v c _ _- ;own of /C 1 C 2 p,5A- c clk.5 (.J l 2 3 S III.Type of Permit: (Check onl�/one box on line A. Complete line B if applicable) A. System ❑ Replacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) B. ❑ Permit Renewal ❑Permit Revision ' ' '❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration . Owner / �!l �i Q I/ IV.Type of POWTS System/Component/Device: (Check all that apply) (/lJ" 5�a� «-r iJeJ Non-Pressurized In-Ground ❑Pressurized In-Ground ❑ At-Grade ❑Mound>24 in.of suitable soil ❑ Mound<24 in.of suitable soir/L^ 1 ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dispersal/Treat ent Area Information: ,elaT•Wf.-.JP ' ' Design Flow(gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required Dispersal Area Proposed(s yste levaatiofi / ��v . 1 S /L�Z) ".?/, 2- rP2 /� / VI.Tank Info Capacity in Total #of Manufacturer =( Gallons ' Gallons Units a, o vo' .= 0 U New Tanks Existing Tanks t c �_;y �. .6 U Vi . C� T. V QI Septic or Holding Tank tar-7C) / cr( /Xy� Dosing Chamber VII.Responsibility Statement- I,the undersigned,assu,- ponsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber'mature MP/MPRS Number Business Phone Number /` /t ds/ / ZC7 79,)----02/7—7x Plumber's Address(Street,City,State, Zip Co i/9� Z i/Z 5/ A/ec J /l l JS _l 7 VIII, ounty/Department Use Only Approved • Disapprov Permit Fee Date Issued Issuing ent Signet e • • . iven Reason fora ••:I $ AY 75. °° /2/13//3 IX.Condi easons for Disapproval / �-, 14 /{GL..J �dyM,CAt,.t,11. 1 Septic tank,effluent filter and `3� ��l I �e e [ � dispersal cell must all be services/mafntaine4 W✓�. 1-4,1'5 �Llftr M1.04, — ' as per management plan provided by plumber. I L / 2. All"Aback requirements meet;beinaintaindd J./ p f rl✓�v�,rn.. T d 1 "....a.,44,6 ae per applicable code%ofdmaices. D G''` ��- Attach to complete plans for the system and sub it to the County only on paper not less than 8 tit x 11 inches in size , /tit f uYL ¢a lid S' '11 . SBD-6398(R0313) . Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 12/11/13 Owner: Gerald Smith Location: NW1/4 SE1/4 S28 T30 N,R18W 1144 132rd Ave Richmond 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 4-6. Maintanance and Contingency Plan 7. Filter Specification.; heet 8-10. Soil Test I Signature License n •-r#226900 PLOT PLAN PROJECT Gerald Smith ADDRESS 11160 190th Ave NW Elk River Mn 55330 NW 1/4 SW 1/4S 28 /T 30 N/R 18 W TOWN Richmond COUNTY ST.CROIX MPRS Shaun Bird 226900 _ DATE 12/12/13 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 931 # of chambers 46 BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Scale is 1" = 40' SYSTEM ELEVATION 92.0/92.1 7' below grade unless otherwise All Vent p p g i in shall be SDR 30/34,within 10' noted of tank,piping shall be Schedule 40. A >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 100' 5.6ft^2/pair of end caps 4' Long 34" Grade at System Elevation 99' A B-2 „ 40' 4% Slop: 30' B-3 61' 2-3' X 94' cells with>3' spacing B-1 11\ 80' 20' B.M.* ST 15' 140' Pro 3 Bedroom House 132nd Ave • Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 99' Vent % Grade Vent 3' 4„ 3' 41/ A30/34 Septic Tank 5' Long gi& 5' S' Long 1 Grade at System Elevation 3 6" Grade at System Elevation Spacing 5' 2-3' X 94' Cells Same on other end Observation tubeNent At end of cell A 23 chambers per cell System elevations: A 92.0' B 92.1 ' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of_______ FILE INFORMATION SYSTEM SPECIFICATIONS / Septic Tank Capacity gal n NA Owner f # .. _ r _ - C Permit# Septic Tank Manufactur e_ ❑ NA Effluent Filter Manufacturer_ -� !—❑NA- DESIGN PARAMETERS ---- - - ❑ NA Effluent Filter Model El NA Number of Bedrooms - - Number of Public Facility Units ;1 -NA 'Pump Tank Capacity gal NA _ __ _ - Estimated flow(average) 300 gal/day Pump Tank Manufacturer NA Design flow(peak),(Estimated x 1.5) --1-0 Pump Manufacturer NA gaUday -.--_- ---- -- `� - NA Soil Application Rare gaUday/ft z Pump Model - -A Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA Fats,Oil&Grease (FOG) 5530 mg/L 0 Sand/Gavel Filter ❑Peat Filter Biochemical Oxygen Demand (BODs) 5220 mg/L 0 NA ❑ Mecharical Aeration ❑Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection _J ❑Other: -_-__- Pretreated Effluent Quality Monthly average Dispersal i:.ell(s) ❑ NA Biochemical Oxygen Demand (BODs} m 530 /L 'c -Ground(gravity) ❑ In-Ground(pressurized) mg/L Total Suspended Solids (TSS) 530 mg/LIA ❑At-Gracie ❑ Mound Fecal Coliform(geometric mean) 5104 cfu/100m ❑Drip-Line ❑Other: ---------Other: [3 NA Maximum Effluent Particle Size 3f,in dia. CI NA ___-- -555----._ Other: ----- -._`.-._ ---y;<■A Other: ❑ NA `Values typical for domestic wastewater and septic tank effluent. Other: -- -.__.---------5555___ DNA MAINTENANCE SCHEDULE Service Event Service Frequency onth'• Inspect condition of tank(s) At least once every: ❑ ears•s) (Maximum 3 years) ❑NA Pump out contents of tank(s) When combined sludge and scum equals one-third(36)of tank volume ❑ NA - -_ --- - —- - --`-- - ❑ month,s) Maximum 3 years) 0 N Inspect dispersal cell(s) At least once every: -. year(s.' _- (Maximum-_ } --_ ---------- -----— ❑month!s) NA Clean effluent filter At least once every: 4 (.ear(s; -__ ❑ rrlonthl s) NA Inspect pump, pump controls&alarm At least once every: . ❑year(s) ❑__ 55 NN_. --- --- ❑month)s) ►rt NA Flush laterals and pressure test At least once every: ❑year(s)Ii-).-- - __ ------ - -- -- ---- ❑month)s) NA Other: At least once every: ❑ • year(s) Other:---------- - ----- - __ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber;Master Plumber Restricted Sewer;POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s)to identify any missing or broken hardware,identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent or the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to chest:for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (6)or more of tl re tank volume,the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordanc.s with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechar ical or pressurized components,pretreatment units, and any servicing at intervals of 512 months,shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of cc mpletion of an!,service event. Page of START UP AND OPERATION For new construction, prior to use of the POW1 S'check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or darr age the dispersal cell(s). If high concentrations are detected have the contents of the tank(s)removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill abDve normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s)in one large dose, overloading the cell(s)and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Ooerator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact,the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons;and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33,Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. . The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. * After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN if the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure,lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC,PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER ,7 Name1 _ _ Phone 7 ,� 3_ !�/ Phone 7�����(�j / SEPTAGE SERVICING OPERATOR(P MPER) LOCAL REGULATORY AU'T'HORITY Name % _ Name Phone 7)( :� ,.- Phone $2.' 4.1.% This document was drafted in compliance with chapter t3PS 383.22(2)(b)(1)(d)&(f)and 383.54(1),(2)&(3),Wisconsin Administrative Code. r'ry° FILTER CARTRIDGE INSTRUCTIONS nN rims Installation STEP 1 Dry fit the filter case onto the end of the outlet pipe to ensure it is ,41i centered under the access opening. If not, then either insert more pipe into the _I,9II tank through the outlet or solvent weld (glue) additional pipe onto the outlet "" pipe. STEP 2 While the case is still dry fitted on the outlet pipe, measure the length _i of 3/4-inch pipe needed to brace the filter to the tank end wall if utilizing the optional supplemental side support. If side support method is not utilized, proceed to step four. 1 STEP 3 For installations utilizing the optional supplemental side support: solvent weld the 3/4-inch pipe onto the filter case. If side support method is not utilized, proceed to step four. STEP 4 Solvent weld the filter case onto the outlet pipe. Insert the filter - cartridge into the case, pressing down until the filter locks into the bottom of m'-• 1 the case. STEP 5 If a VRS switch is utilized: insert into the filter and lock by turning clockwise 90°. Maintenance 1. The effluent filter should be cleaned every time the septic tank is serviced. 2. Open the outlet access opening to inspect the tank and filter. 3. Pump the septic tank completely, making sure to remove the sludge R layer on the bottom of the tank and not just the scum and effluent. 4. Once the effluent level has been lowered below the invert of the I outlet pipe, firmly pull up on the filter handle to dislodge the _ ` " cartridge from the case. 5. Slide the cartridge up and out of the case for cleaning. 6. If a VRS switch connected to an alarm is present, the switch :t_4::;it.,,,,,:44,11,14L4...s hould be removed by turning counterclockwise 90° and cleaned with water only.7. While holding the cartridge on its side (large flat surface facing ' .down) over the access opening, rinse off the cartridge with water .only, making sure all septage material is rinsed back into the tank. = 8. If VRS switch is utilized, replace by inserting into filter and turning clockwise 90°. 9. Insert the filter cartridge back into the case, pressing down until . " w M _ - .i the filter locks into the bottom of the case. .' �10. 10.Replace and secure the access opening on the tank. BEAR ONSITET"FILTER CARTRIDGE-FIVE-YEAR LIMITED WARRANTY Bear Onsite filter cartridges are warranted to be free of defects in material and workmanship for five(5)years from the date of consumer purchase. BEAR ONSITET"Filter Case-Lifetime Limited Warranty Bear Onsite warrants the filter case will be free of defects in material and workmanship during normal use for the period of time the original purchaser owns the product. If a defect is found in normal use,Bear Onsite will,at its election,repair,provide a replacement part or product,or make appropriate adjustment.Damage to a product caused by accident,misuse,or abuse is not covered by this warranty.Improper ■ care or malfunctions resulting from units not installed,operated,or maintained in accordance with instructions provided will void the warranty.Proof of purchase(original sales receipt)must be provided to Bear Onsite with all warranty claims. Bear Onsite is not responsible for labor charges,removal charges,installation,or other incidental or consequential costs. In no event shall the liability of Bear Onsite exceed the purchase price of the product. Located in part of the Northwest Quarter of t 25 _. .26 - . 2750. Easement tar Prole., Grass �G 5 -- Frssdrvvtra7 968. ..._ --- �- 966.9 ....• .. S89'53'36"W 170.00' N8 i ...- 203.35 963.4 �, .• -- 4 1 X79'28' 5 0,93 6r 10.04 to Ul -+A V z r•; C7 ter. i 38 37 . ED 36 „h. .p V 1.86 acres 1.81 acres 2. 1 2. 01 acres 80, 901 sq. ft. 78, 767 sq. ft. 91,88 87, 407 sq. ft. Ig CP. • • f• 23.41' 3.4 81-5-92--- � __ - -.., .. . �� W ___ _C23 .44 89'25'18" E 5 21 ; �2 5 8 4 -.___ t 104.81' / ‘ 105.00 "~- k6- ' " e . is 45 x, . C27 E 392.28' k N 10 200 - ==.:,.;--- p. `76 5- 260.1 6 -° — ' --.,. /r4.. -N 84'27" E 196.57 t l4a0` a Gel,,, 6,44 88.60 2 39•; 28{2P. 0;/ 1`25.18"W 241.00' , �,,,! . 182.14', _ t . 959.8 ' ,r"r/�, ,� ' -- . -di S27-25105"W g S3 27.23% • A..:c ,0-2^.., 03 2L Cu St Crcx Cou'-y PlartZorti,g 715-3136-a686 212 ST,CROIX COUNTY SEPTIC'TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer e✓ S tut T� Mailing Address___fro ! %. ' AIL() .� 2; IA 533D dr Property Address //j " % �,,_� 4z . 46 fication required from Planning&Zoning Department for new cons tion.) City/State Parcel Identification Number D'02 A-1°79 f—34 LEGAL DESCRIPTION 2,�, gw, ZCZ../A-2--t.e. Property Location4/�4 )v .Sec2 g T v R Town of Subdivision Plat: "2✓ Lot# Certified Survey Map# '--' / ,Volume ,Page# Warranty Deed# 0 (� (before 2007)Volume ,Page# Spec haus 410 no Lot lines identifiabl yes o SYSTLi4I MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of ycur 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. Whet you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in§Comm.83.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zoning Department a certification form.signed by the owner and by a master plumber.journeyman plumber.restricted plumber or a licensed pumper verifying that(I)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 l'3 full of sludge. I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein,as set by the Department of Commerce and the Department of Natural Resources,State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning& Zoning Department within 30 days of the three year expiration date. )/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s)of the properly described above,by virtue of a wawa deed recorded in Register of Deeds Office. Number of bedrooms SIG T • OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department.*** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.08/05) 1 82469E, 1 • State Bar of Wisconsin Form 3-2003 KATHLEEN H. WALSH REGISTER OF DEEDS QUIT CLAIM DEED ST. CROIX CO., WI Document Number Document Name RECEIVED FOR RECORD 05/08/2006 10:40A1 QUIT CLAIK DEED THIS DEED,made between Dennis F.Ball and Nancy A.Ball,husband and wife ELM- I 13 and David A.Ball and Kimberly A.Ball,husband and wife REC FEE: 13.00 TRANS FEE: ("Grantor,"whether one or more), COPY FEE: and Richmond Acres,LLC CC FEE: PAGES: 2 ("Grantee,"whether one or more). Recording Area Grantor quit claims to Grantee the following described real estate,together with the rents, Name and Return Address profits,fixtures and other appurtenant interests,in St.Croix County,State of Wisconsin ("Property")(if more space is needed,please attach addendum): i • .._:- : ::' See Attached Exhibit"A". - • '.r �� ,,. D This deed is being given by and between all parties relinquishing all right,title and , ~• --• ' 1-;%1 C•-i 0' interest they have in that certain Agreement dated May 16,2005,recorded June 3, 2005 as Document Number 796642. 026-1082-40-000;026-1082-70-000; 026-1082-95-000;026-1083-10-000 Parcel Identification Number(PIN) This is not homestead property. Dated 4 6-Y 6' . * 1 — /—- ig (SEAL)_arita'_ _ (SEAL) _Dennis F.Ball *Dh 7- Ball & ? i (SEAL) , G ` (SEAL) * ancy A.B 1 *Kimberly • AUTHENTICATION ACKNOWLEDGMENT Signature(s)Dennis F.Ball and Nancy A.Ball,husband and wife STATE OF I,1Y1 .3r1. 1f1 ) authenticated o P. ,5'6 )ss. . C rDIX COUNTY ) * I,RU k)ADoce-c-- Personally came before me on_•__r___y_ TITLE:MEMBER STATE BAR OF WISCONSIN the above-named David A.Ball and Kim berlv A.Ball,husband (If not, and wife authorized by Wis.Stat. §706.06 .4 piliguC to me known to be the person(s) who executed the foregoing yte strument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Of PM, t' o _t hors, 01. l,);ilit aml►• Attorney Kristina Oland tR E P, F 3 Ghctz 4n../ Hudson,WI 54016 6 .W tary Public,State of IAA $ s, ..,--...-# y Commission(is permanent)(expires: —/lo-b9 ) (Signatures ma ed or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. AN ODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. QUIT CLAIM DEED C 2003 STATE BAR OF WISCONSIN FORM NO.3-2003 *Type name below signatures. INFO-PROT"'Legal Forms 8004355-2021 www.infoproforms.com 1 of 2 EXHIBIT "A" Parcel 1: The East Half of the East Half of the Southwest Quarter(EWEY ISW%)of Section Twenty Eight(28), Township Thirty(30)North,Range Eighteen(18)West,Town Of Richmond,St.Croix County,Wisconsin. EXCEPT Lot One(1)of Certified Survey Map filed Aprli 24,1990,In Vol.8 of C.S.M.,pg.2199,as Doc.No. 457843,being part of the Southwest Quarter of the Southeast Quarter(SWWSE%)and part of the Southeast Quarter of the Southwest Quarter(SE%./SW'/.),both In Section Twenty Eight(28),Township Thirty(30)North, Range Eighteen(18)West. • Parcel 2: The West Half of the Southeast Quarter(W'Y,ISE%)of Section Twenty Eight(28),Township Thirty(30) North,Range Eighteen(18)West,Town of Richmond,St.Croix County,Wisconsin,EXCEPT the following described parcels: 1. Lot One(1)of Certified Survey Map filed Apr0 24,1990,in Vol.8 of C.S.M.,pg.2199.as Doc.No.457843, being part of the Southwest Quarter of the Southeast Quarter(SWWSE'/.)and part of the Southeast Quarter of the Southwest Quarter(SE'/JSWY4),both In Section Twenty Eight(28),Township Thirty(30)North,Range Eighteen(18)West; 2.Lot One(1)of Certified Survey Map flied August 13,1981,In Vol.4 of C.S.M.,pg. 1093,as Doc.No.372738. being part of the Southwest Quarter of the Southeast Quarter(SW%/SE'/.)of Section Twenty Eight(28),Township Thirty(30)North,Range Eighteen(18)West; • 3. Commencing at the Southwest corner of Lot One(1)of Certified Survey Map filed August 13, 1981,In Vol..4 of C.S.M.,pg. 1093,as•Doc.No.372738,for the point of beginning;thence N89'59'15"West 20.00 feet;thence N0.01'41"East 282.00 feet;thence S89959'15"East 224.00 feet;thence S0'01'41"West 15.00 feet;thence N89'59'15"West 209.00 feet;thence S0.01'41"West 242.00 feet to the point of beginning; 4. Commencing at the Northeast corner of the Northwest Quarter of the Southeast Quarter(NW'/4SE%)of said Section 28;thence South 16 feet;thence Northwesterly to a point 10 feet West of the point of beginning,thence East to the point of beginning. • • 2 of 2 Wisconsin Department of C - - W SOIL EVALUATION EPORT Page of I Division of Safety and B ildi 4 ' accordance with Comm 85,Wis. Adm. Code ^e, Attach complete site•v paper not less than 8 1/2 x 11 inches in size.Plan m r. f ref✓Q include,but not limited to:vertical and horizontal reference point(BM),direction and' Pa percent slope,scale or dimensions,north arrow,and location and distance to nearest road/ r�i — 1�9�j1 , - 'at,1) - Please print all information. i;;_ x'61 vie by - / Date / Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04()"-(4 y 1 /Z/G//-3 ✓4, ff Property Owner Property Location' n Ge✓y J fx.. Govt.Lot411 1/4,01/4 S `5 T30 N R/1� E(9 Property Owner's Mailing Address Lot# Block# Subd. Nam or CSM# VVV City State Zip Code Phone Number ❑ City Vill e To Nearest Road 2/k R,i. I/l JI s533o i ( ) irr-t i i362.t. Ate-- New Construction Uses tesidential/Number of bedrooms Code derived design flow rate rJr) GPD ❑Replacement ❑ Pu c or commerdal-Describe: _ ___ _____ _ Parent material eu «.X. .p Flood Plain elevation if applicable /L/ ft. General mmen comments - aele� �z f 7(7( and recommendations: q p� System Type .9P�� • `� System Elevation ?c . 0 /aZ. / Boring# 0 Boring Q} /7 pit Ground surface elev.s// v ft. Depth to limiting factor /021(v 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 / �4 yoy�3/L ...Z �� rm� es-- aw - C - 8 a ���� joy,s-/7 6i AS. % �,��.J it - ' - / ./�-/ — f /-.�' Os 41/ tii. A/� Ls A 0 qZ Ii , )t W it I I Boring# 0Bon� p 7 pit Ground surface elev. ft. Depth to limiting factor /d` (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 2- /s— J /-. ,I /a} -4 - r 3 i—, - , /144A- /t'/'I - /< 47 /� I '17— i( tt , 7o ,0 •Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 • •Effluent#2=BOD5<30 mg/and TSS<30 mg/L CST Name(Please PrinU %, . re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address 40 Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 /02 '"1`-c 715-246-4516 Property Owner_ Parcel ID#_ Page of Boring# ❑ Boring J ® j pit Ground surface elev. �n ?ift. Depth to limiting factor / in. 1 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 1 Q—a 4,3/-z_ ,- L ,1,2 rn c„--- A"-- , b - g Z /3-] �..>7% C I it . r y2 .1 - 3 3 ?a-84 /U,id _p> / �i 11/9- . 5 /: 5 fy- ❑ 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 GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 0 Boring Boring# ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 *Eff#2 Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/l_ *Effluent#2=BODS<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,please contact the department at 608-266-3151 or TTY 608-264-8777. SBD.8330(8.6/00) Property Owner Parcel ID# Page of Boring# ❑ Boring pit Ground surface elev. ��f . 1.---ft. Depth to limiting factor /3.4 in. 1 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 2 - , m Tit. 2v i Z - 3 3 ��•t34 /U�.� .....____- P..5" g _ nI/ "'it 1v.X-- . S'/' a Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 'Eff#2 ❑ Boring Boring# ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon lepth Dominant Color Redox Description. Texture Structure Consistence. Boundary Roots GPD/ff? in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 'Eff#2 •Effluent#1=BO;>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BODS<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or contact the department material in an alternate format,please c artment at 608-266-3151 or TTY 608-264-8777.p SBD-8330(8.6/00) Soil Test Plot Plan Project Name Gerald Smith Shaun : s Address f 11160 190th Ave N W Elk River Mn 55330 CS 'f #226900 Lot 36 Subdivision Richmond Acres Date /11/13 N W 1/4 S W 1/4S 28 T 30 N/R18 W Township Richmond ❑ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 2" pipe 1' above grade System Elevation 92.0/92.1 *HRpSame as Benchmark Scale is 1" = 40' unless otherwise noted 100' 99' B-2 „ 40' 4% Slope 30' � � B-3 60' B-1 LI 80 B.M.* 140' 132nd Ave V I Wisconsin Department of Commerce \- EVALUATION REPORT Page__J^of_ Division of Safety and Buildings C--c9� �,.! r with Comm 85,Wis. Adm. Code County C.-�• Attach complete site plan on paper not less than 8 1/2 x T.A.c' - J I �� i include,but not limited to:vertical and horizontal referen• point u,� 41 1 Parcel I.D. �/;G,1,3/ ,1 percent slope,scale or dimensions,north arrow,and to ion and distance one= road. a L 7 Id Please print all informa on. � Re ' wed by Date AUG ( V2-3/4& Personal information you provide may be used for secondary p poses(Privacy Law,s.15��t'i�(m)). G��/Yt�Y�� Property Owner L ! ST.CROIX G NIt}y cat Sw Geraid 3'. 5t� 1 1 , ZONINGtGbpt(1Lot S 1/4 sE 1/4 S a9 T30 N R 1 E(ore Property Owner's Mailing Addre Lot# BI Subgr game or CSM# 1 11 100 190 Ace. N'w 340 Plat o F (Z•,chyv owl. Acres City State Zip Code Phone Number ❑City ❑Village ®Town Nearest Road Fii 1"eR I rINI 5533D1 ( 763)4/W11-$88 e R∎LHr. oNIa L'I 13a " �1ruc. - [. New Construction Use:[B.Residential/Number of bedrooms 3 Code derived design flow rate__47 4450 _GPD ❑Replacement ❑ Public or commercial-Describe: — - — Parent material 0 2_1 uJ CA-S 1"-% Flood Plain elevation If applicable _ ft. General comments = SV 5 5 a s+ c.. L •7(.7 5 t 'Slog.t 1 a s..a 1 1 rw p.a r,S 5 c t 41,....1- /00,73 and recommendations: MD?cmd 0'? 4oT37 c%v-al Ah - 3E,4azcrdiLA (be,Secg Of ' Ioo. a3•co -!'a..r • ❑ Boring q[� _iiii Boring# 1 p ,3 ft. Depth to limiting factor �Q in. pit Ground surface elev._ 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 D_I t3Y2 '��° -\- L cbK ,',- v a c, , Li , 1 ,-3/ ,`',SYR 5/L �_ .__ 4:-'-.. ? bk r,,,,, Y C J C , y , T5' 3 11-‘co 7,S Y '4/4 _ ....� -.- ,; \rn� �: m ■ G t.� _a 4 - 5R4/4/ c-I C=7 GYR 1, ft: 1- r-v,,-v:vy,-'; -- --- % A . 5 a Boring# Boring R Pit Ground surface elev._T9.`Q 1 ft. Depth to limiting factor 7-5 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G PD/ff In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 D-Iq /D1'R % 1 C a Sbk rY4r a LJ a-c . 4 , g 15-3V `7.5YR `4 F(;l_f a rn5101S .M4 r c1/4,L3 , )C. 3 3 75-1.5YR S/si _._.-- f,' I C 5 bl., vv-4 v- --- , 5 1, D _f_a4c .- *VI—`1,6YR `A-I V-F51(,, a,_. • = > <220 L and TSS>30<150 mg/L C •Effluent#2=BODs<30 mg/L and TSS<30 mg/L Effluent#1 -BOD 30 mg/ _ s CST Number Signature T Name Please it) 9 Add ss .i.`, s.,} Date Evaluation Conducted Telephone Number :51. 1 as-OS ` 6 aya:358s -r �,�rro�z�°;a w . s � Property Owner Gera Ids Z; 5rn,4k Parcel ID# Page CK_of 4/ 3 Boring# ❑ Boring A Pit Ground surface elev.I OG_S y ft. Depth to limiting factor 75 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 'Eff#2 / o-40 ioYR3/ _ - . . Ps L. aFtK mFr a,w OF , y , S a /o-3 iowo F5L a, FSb14- r fr C...0 IF . y - 8 3 3-y ' 75125/y VF$ 1F-56 Pt— Yet?• ` C w I uF • V V NS-?S '7.sv t1/ tVFt b v8 - A 13 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 GPD/ff In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 'Eff#2 Boring# ❑ Boring ❑ Pit Ground surface elev._ ft. Depth to limiting factor _in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure I Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. `Eff#1 'Eff#2 • •Effluent#1 =BOD6>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD5<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330(R.6/00) Property Owner Gera I& V r SPY)�4 1 Parcel ID# Page or::' _of 9 3 Boring# ❑ Boring 1'pit Ground surface elev. I 00•S y ft. Depth to limiting factor 75 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 o—/o I 0112-3/ PS L a F40k m Fr 0..W OF . y , 0 I g ,o-+ iol(014 .-. _.....,. F$L aFSbvi- mC-* - C.,,) 1 • / , ' 3 a3-yg -z 5Y(45// V Fs 1 F-5,6 frt... rte' . c t.--' i tiF . V . L V8-75 -7.5Y(2-44; - uFSct- I MGbK. h+F∎ --- , 0. , 3 Boring# ❑ Boring ❑ Pit Ground surface elev. _ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 'Eff#2 Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure 1 Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 'Effluent#1 =BODE>30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=8OD5<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330(R.6/00) 170 N£ '1 l scaly Qc.-S� `1 5EIA j5wYy 1Sec. 28,T3bmi J?/S(4 `' -- DotiA4 7-s .rA- JUW Y sIV1 c s t aa ri 4 tp s 4)'11.1 5 Eyy \ \ lv SC•Ak• / '•117V D I \ T r `-� {;nt \ \ `Oq vV 1 ,31 ac.rG 4Q /at \ / a a 0 1 "To p u- & W c orp,4 - 2. 6P \ \ 5=l ce.k Sv w c , pc_ °o a. 10 Ut„ NE corm r `� StL41 V Sur a- 7 c I a 9 ., 9 1:3 iO4-(...1L-In De- p;-‘.., \ . . .he v F e 4)u.) \949 .e.1cu0.t : oYv ./ Q hn 1 /00100 v c . +\,10 t.2. BM 1014 .00 - re eci . Lp45 E\ 9(3, 13 ' 1- 1ob .9y too a,3 • • "Lo+310" „i„. E \ \1 \� `. 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Ali L %0s l # 4 : / i'lli.� 9626 \' .cre j ages p ` t v '.1 x`26'\ �, 1�}7=acres \ ' �\ ' AB.4. !, ��L(.73 acres /'N ' 1° Z 6q ot�res� T --_ 7• 4 1 Ir. \ r�J .2:,6 c c .., it, S'B'A - ,2.+14 f.`acres , .24 r"7 962.0 ! ..1., 1 N.B,A. (97 aLxes \` ` 92'` 972e 1 2,5 acres x l o0,. f' l } 1.26 bcre$' ,1I \� --\ 2 a 72 2.40.-0,1. 960.7 1 Ices i 9 513 l '1 I r , . t N.R.A 1+ 2.25 acres. / 1 , x \ 2.40 ac g- � I ... .. N �\ � \ 2 0,C / l / i N,, ti \j z L.,1- 233 ' x \.2\03' 964'5 ' O 0 2 , 2A ''''':77 `.T 2 x964.6 �� \ ' :1 . j 66 � �- 2. 1 aches s� : i 8:A , ..,. a 21B acres ~ 51::B:)6‘ 1 ._. -il 404-o , '` ,s .¢.., 9632 1 ' ,37 `q ', - r95\ 2001 31 - 6 •; 3- /38---,. `,` '',4 , acres 1.581 acres 2. 111. ' .I acres 1 ) 72.0 � NB.A. 1 _2.�J1 0,Gre.S'., N' .A. %1. N.B.A. r>' fl '.N.B.A. \ 1.86.,acres 1 Be`_pere ) 2.11 acres �i 1�],.�! 2.i)1 acres 9602 1 /` �1 � ` .....'. . 0 acre _yt' "� h 1. S O 2.. c31' U re s x.', -•,` ` ---A r ! '1,62 acres s '1• NB.A: y ' r 1.90xocres.. ■1 NB.A I j \5.0 ) i 9390 1 1 ( 966.8 \'./,7.B.A, s7,e \ ,,s 2. acres. 1 1 x 1 171 __ _ \, 1.b`2 acres(i .. t ! _ / I b . 103 z �d�1 i . 105, / _ ' ) •� ,228, _ J - " y � i\ / : _ � . r. I 6� A- _ - -1. / am �� � " '960.7 i 1 959.2 ,, ..... .. z___L_ 44 46 42 J. .,-7 ages' - \I96 acrds9' 1 (N 1 967.3 if 1. 79 acres 1. 74'-peres 4� 4t V1.83 acres e N.B.A. 19ff acres. • x N.B.A. NB.A...,/ N.B.d). -\2:97 acres - I 1.79 acres 1f6J`acres 1.'7 acres 1.74 ocrZ� NB.A.' 2:76 aGrGS ) /` 96x9 " 284\ 2.l3 aEr e$ 9117 !} iT fr 968.7 x .. I 1 : 2.63 acres 7 I1 /. B� 1' ` 971., i"j t �'%7.3� 9nn' "t i #so' 780' 0' 47` '`\.