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Home My WebLink About020-1146-90-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division p ~ INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Bast, Merle Hudson Townshi ;ST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ ~~ ~ ~ ~ 4 /1!C)C) D 6eu Holding ,Y........ _ .., .... .. ,. ,~_ TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 7 „7~ 7 ~i ~ ~ Dosing ,7 Z~ 7~ ~ ~ f Aeration ...., ,. •.-_...~.,.. , ._. Holding ...., .... ,.,,_..._.,... .. .. t,.. PUMP/SIPHON INFORMATION Manufacturer Demand ,._,..... _ ...... ...~.... GPM ~ ` Model Nu er , ~~"' . TDH Lift 'ctien.l,,,Qss System,.lieBd`"~ TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: $t. CroiX Sanitary Permit No: 463266 0 State Plan ID No: Parcel Tax No: 020-1146-90-000 Section/Town/Range/Map No: 26.29.19.778 STATION BS HI FS ELEV. Benchmark ~ ~ ~ ~ r , `-, !a~ , ~g ., Alt. BM Bldg. Sewer ~1 ~ Y~ ~ ~ SUHt Inlet ~ .~5 ~8. y 5 St/Ht Outlet ~1,qS ~s~ . Z 5 Dt Inlet ~ .i` Dt Bottom ~~ \. Header/Man. S ,~S 9r ~ ~ 'JS Dist. Pipe ~ ~ r,1..7 ` ~ c 7 Bot. System q `gs 1 ~~ . 3 S Final Grade 7.S i St Cover F- ; \~ -z •~3 ~ b 3 /~ BEDITRENCH DIMENSIONS Width ~ ~ Length No. Of Trenches PIT DIMENSIONS No. Of Pits "`-- Inside Dia. +-- Liquid Depth ~.. 75 C3 ~ - / l• e~` `_ SETBACK T SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturerg; (? 1 (`f~~ p Q't- INFORMA ION TypeOfSys te,~~; / ~Z~ ~` ` J ~.`/ / `~' /~ (~/ UNIT Model Number: ~'t_~ `~-' ~ ~ emu l IIISTRIRIITInN SYSTF_M 17 ,~...: 1_ ZI_ tr4-~,SL Header/ManCifo~ ~~ Distribution Pipe(s) ~ \ x Hole Size x Hole Spacing Vent to Air Intake Z5 th Di L \ acin th Dia S Len a_ eng g p g C(lll CnVFR ., o.e~~..~e c..~+ew.~ n.,i.. .... 1111n~~nr1 nr A4_[~rarla Svstams Only Depth Over i' Depth Over xx Depth of ~ xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges ~ Topsoil I _ Yes U No Yes ~] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 753 Blue Jay Lane Hudson, WI 54016 (SW 1/4 SE 1/4 26 T29N R19W) igh Meadows Lo ^13 Parcel No: 26.29.19.778 1.) Alt BM Description = ~~, (~ 1.;. J (/` ~2v`c,~ M,~~,( ~S ~C'S~ ,1 2.) Bldg sewer length = ~ ~ - amount of cover = ~ ~~...~:.;.~,5 ~ ~c "~ ~ O~ ~~ f . _ _ _-_~ __._.._.___ _- f._. _.. I Plan revision Required? ~ ]Yes No j L~ ' ~ ~~ ~~ ~ Use other side for additional information. ~.__~__J~ ~_ Date Insepcto G Signature SBD-0710 (R.3/97) U1 ~• i 3 ~ ~~ Cert. No. Safety and Buildings Division County t. ~ ' ' ` 201 W. Washington Ave., P.O. Box 7162 Madis WI 537 - t /~ ~~~-- `~ C O~5 j~ on, 07 - 7162 (608) 266-31 " Sanitary Pemut Number (to be filled in by Co.) Department of Commerce ~~ Sanitary Permit Application Plan I. .Number In accord with Comm 83.21, Wis. Adm. Code, personal information you a 'de ~ ~' ~~ l,. ~ ,L~ ~j/ ' may be used for secondary purposes Privacy Law. s15.04(ixm) ~ ~~ ,' A (if different than trailing address) L Application Information-Please Print All Information ' " ~iy~ ~0 ~nj ~ ;• z Props s _ ' ~ O ~~ P ~ Block # ` Pro 's Mailing A ~ ~~ ~~ petty 'oa ~ l~K't/Y~ ~ t~ S i ~y~ ~ City, State Zip Code Phone Number l ect on . ' 7 ~ ~ ~f (~ rcle ~ ) ~ ~ ~ It1. of Building (check all that apply) ~ T N; R E W Family Dwelling - Number of Bedrooms ~ ~ ~ Subdivisio ame CSM Number PublidCommerc3al-Describe Use State owned -Describe use 3 S C w C'rty_ village wnship of III. T ype of Permit: (Check only one boz on line A. Complete line B if applicable) A' System Replacement System TreatmendHoldi Tank R ng eplaocrr>ettt Only Other Modification to Existing System 13 • Permit Renewal Permit Revision Change of Permit Transfer to New Ltst Previous Permit Number and Date Lssaed Before Expiration plumbs Owner IV. of POWTS S s tem: (Check all that a I 'zed in nd Mound Z 24 is of suitable soil Mound < 24 in. of suitable soil At-Grade Single Pass Sand Filter Constructed Wetland Pressurized in-Ciro _ -- EI Tank Peat Filter Aerobic Treatment Unit Recrrculatiog S ~~ ~~ Recircu Syndre6c Media Flter " g Chamber 'p Line Gravel-less Pipe (ea 'n) J~ / V. Di rsal/1~•eatment Area I orma /. (`~ ~' G ~~., Design Plow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Regained (sf) Proposed (st) S Jv ~ ~o i ~ , VL Tank Info Capadty in Total Number Manafacnrrer Prefab Site feel Fi Plastic Gallons Gallons of Units Concrete Constnrcbed Glass New Existing T Taoks Septic or Holding Tank Aerobic Treatmwt Unit Dosing Chamber VII. Res ottsihility Statement- I, the and a respousi :lily for iastallatioa of the YOWTS shows on the attarJted ass. s N Plattdrer' 1~R,S,pjum>x~ ~ ~ Business Phone [ ' Plumb er s Addces~S.6Stnxt, City, State, ) / ~ " /De t Use Onl Approv Disapproved Su ~ e ~ t Fee (' dludes Groundwater ~ .Date Issued Agent 'gnature (N ) O Gi a ~ d ~ lO~ ~ wner ven Reason for Denial - Q IX. Conditions of Approval/Reasonsfon Disapproval ~QTFM (1\/VNFR• ~ ~~ 7 eptic tank, effluent filter and ispersal cell must all be serviced /maintained as per management plan provided by plumber. aintained as per applicable code/ordinances. --- Attach complete glans (to the County only) far the system oa paper not less than 81lL x It inches is atu PLOT PLAN PROJECT Merle Bast ~ DRESS 3005 Damon St. Eau Claire W 54701 SW i/4 SE 1/4S 26 /T 2 /R 19 W TOWN HudSOn COUNTY ST.CROIX 12/12/04 BEDROOM 5 MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN-GRO D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/630 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1119 # of chambers 36 ,BENCHMARK V.R.P. Top Of 1/2" Pipe ASSUME ELEVATION 100' Filter ZabelA-100 ^ BOREHOLE O WELL * H. R. P . Same as Benchmark Alternate Benchmark „ SYSTEM ELEVATION 97.4/96.8/96.2 3.5' Below Grade Top of 1/2 pipe @99.2 Well is to meet all setbacks required by WDNR Plans Designed Using Conventional Powts Manual Version 2.0 Pros ~,,'~%~ Bedroom O House 10' 20' 1 ~~ 3-3' X 75' Cells with 0 >3' Spacing -2 >6" of Cover Combo Septic Tank Scale is 1" = 40' unless otherwise noted i 40' 225' 5' f ... *B 1t.B.M. 100' B-3 1Q.t;10' 7% Slope 'ents Vent Standard Biodiffuser 325' Leaching Chamber Property with 31.1 ft2 of Area Line ' 11" 6' Long „ , „ Grade at System Elevation PLOT PLAN PROJECT Merle Bast ~ AyDDRESS 3005 Damon St. Eau Claire Wi 54701 SW 1/4 SE 1/4S 26 /T 2 /R 19 W TOWN Hudson COUNTY ST.CROIX 12/12/04 BEDROOM 5 MPRS Shaun Bird 226900 DATE CONVENTIONAL XXXX IN-GRO D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/630 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1 1 19 # of chambers 36 ,BENCHMARK V.R.P. TOp Of 1/2" Pipe ASSUME ELEVATION 100' Filter ZabelA-100 ^ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION Alternate Benchmark Top of 1/2" pipe @ 99.2' Well is to meet all setbacks required by WDNR Plans Designed Using Conventional Powts Manual Version 2.0 Pro 5 Bedroom House 10' 20' B-1 7 3-3' X 75' Cells with 90' >3' Spacing ~~ B-2 >6" of Cover 97.4/96.8/96.2 3.5' Below Grade Scale is 1" = 40' unless otherwise noted Combo Septic Tank 40' 225' 5' ~ 1t.B.M. B. 100' B-3 10';10' 7% Slope Vents nVent Standard Biodiffuser Leaching Chamber with 31.1 ft2 of Area 325' Property Line 6' Long 11 " ,, ,, „ Grade at System Elevation !RECEIVEC~..-..~ 1~~~~- WisconsinDepartrnentof 'n ~ ~ SOIL EVALUATION EPORT Page ~ of 3 Division of Safety and Buil i gs ~ t.l ~ 1/ ;~ ~ ~ [7 (~ ~, m auwruan wnn wrnrrr aa; vvis. ram. ~.uue C~ County /1 Attach complete site er not less than 8 1/2 11 iru t re~~i~ (~dfl~i5t lan on a ~ ` (, l p p i p indude, but not limited to: vertical and horizontal refere ce pom~ . ~~r~{3'~~d Parcel I.D. (/ O dQ~ O~ `I ~ ~ percent slope, scale or dimensions, north arrow, and I ` Please print all information. R Date Personal iMormation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~uji/l/1~ Properly Owner J Property Location ~ '~ J t L'i/~ ~ ~,ti ~ Govt. Lot ~~ 1 /4s~1 /4 S p~~T ~ N R E (or W Property Owners Mailing Addre Lot # Block # Subd. Name or CSM# City S tat e Zip Code Phone Number ea r est Ro d ^ City ^ Villa Town N / ~ t~ !/(/ ~ J ! ~! ( ~ ~ J A / ~/G ~h Nwv Gnstu~ien Us Residential / Number of Ye~rNms ~ Cwe ~erive~ ~esi~n t1aw rate GPD ^ Replacement Public or ce mer 'aI -Describe: ________ __ _-______.__ ___ Parent material ~ Flood Plain elevation if applicable ~~~ ft. General conuneMs / Cj / and recommendations: ~' y s / G [ J~(~C~~i < ~` ~ ~ (v ~ p Boring # p Boring f Pit Ground surface elev/ ~~ ft. pepth to limiting factor /~Z n in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftt in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. •Eff#1 •Eff#2 d ~ O ~ 31z ------ ~ .~ - ~ O ., 7 ~, ~~ # Boring ~~~ /7 pit Ground surface ele~~ ft. Depth to limiting factor ~~~L in. Soil Iication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 a ~ ~~ r-- ~ ~ ~ -~ < v ~- 3 ~ s ,--- ~. l~ O • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 nrg/L 'Effluent #2 = BOD < 30 mg/L and T55 < 30 mg/L CST Name (Please Printl Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 rO~~~--~~~ 715-246-4516 Property Owner _ Parcel ID # Page of ^ Boring 3 ~~ # pit Ground surface elev. ~_ ft. Depth to limiting fades `/~ y in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 o- g ~ ,- 3iz/ a----- s / ~ ~ ~ ~ ~_ r ,b ~~ V ~ N~^T ~~ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Coles Redox Description Texture Structure Consistence Boundary Roots GP D/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 ication Rate horizon Depth Dominant Coles Redox Description- Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Cdw Gr. Sz. Sh. 'Eff#1 'Eff#2 `Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 < 150 mglL `Effluent #2 = BODS < 30 mglL 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. SB0.8330 (8.6/00) - Soil Test Plot Plan Project Name Michael Spencer Shaun Address 723 Laurel Hudson Wi 54016 Lot 13 Subdivision S W 1/4 SE 1/4S 26 T 29 Township Hudson Boring ~ Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1 /2" pipe System Elevation 97.4/96.8 *HRPSameasBenchmark Alternate Benchmark Top of 1/2" pipe @ 99.2' Meadow Drive High Meadows N/R 19 W CSI #226900 Date 10/25/04 COUN'T'Y ENtEN'T ST Ciro ~NpNCE A~~ , t ' ~SBP'~IC'T ~N~ ~ ~ . gORM .. ~ . Dy~g,.SHIP CER,p~CATiON s ~~f~l .,,,~ , ~ , ~~-~T ~ ~./.. ~ _ orb/ ~wner/Suyer , .. _ ~ ~ ~ .. ~~g Address - _ _~ ~ ~.:,.~-~ nt for new coastsucuoa) .._-- -~-""" ~J~ Departmc uvf7 Property Address P U Zr~ ' // `~ U _ ~~ / ~y~'tcatioa nQ~d f~ W ~ 1 ~ Parcel Identification Number . CitylS.tate T FGA TFSG TIO ~ / T N~~W, Tawn b prop~Y LO~ab.~-- iPage # Subdivision .~- ~ Volume 1---~--•--' ~ ~~~( ~,Page# Certified Survey MaP # .. ~ ~ t~I(J D .volume.------- .~.~.~- Warranty Deed # Lot ~~ idontifiable es ~ no house nO ~ewaates. Pmper,ms~aee Spy failure to yt into the sysum stem could result s'a its prema~ ed u~ ~Yhst you p of your SoF if seede s licens . P per use sad ems, three 3'earsffige is the waste disp°sal sY~7°a' the owner sad by s as a tceatm~ ~~,catioa form. siga~ cm out the sep ~terdisposal cyst c ~~ Qn. of tha septic ~ a on~ite warto 1~ ~ of alud8 bmh ~ ~, Croix ZoaiaS d ~ Verifying ~t tl ~ ~ is less t~ e. The prey °~ agr~ rd~°tedplumber or s license ~g (~. necessar!'): ~o scP d ouraeYm~ piumberi inspeetioa ~ F~ ~ System with the ataadar ~terp~plumboperatia8 coadttsoa and/or (2) a>~ . fain the private sewage dispo ~~ 3i ~ agree to n~in t of Nam sources, 5tatCo~ ~ °~° g ~urnfica d have read the abo~ of Commie ~ the DeP~ ed to the St. ~ GYoix I/we, the. u et by ~ ~~''°~ . taiaed must be coazpl~ed sad nom` , set forth, heru'a+ sysu:n has bees soam ',~ ,~ stating tlsst y~ ~ lion date. /DATE days of PLICANT owper(s) Si(}rlAl'[TR~ OF , Imowlcdgc. I (we) am (are) the ts.oa this form sre truc to the best oifster of Deeds Offme' that all statemea of a yyarraaty deed recorded ~ Reg `? / ~ i (we) certify / p`! the pro desccibod above, by ~° DATTE g ppPLICAN'r 't being nvoksd by the Zoning DePa~ieat.'~'"' SIGNAT't~ G ~~ may malt is the sanitary Perna ssssss pay iaforms-tionthat is mis• Ister of Deeds office deed stud warranty deed from rho Rog' de in the watzaaty i tiestiot+: a of the Cercificd survey maF tf reference is ts>2- ~: Include with this PP a copy 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 # If system fails, determine cause of failure, use ~ `~emate aria 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 715-246-45i 6 St. Croix County Zoning 715-386-4680 Pumper Tom Mondor 715-246-5148 Shaun Bird #226900 ~~~~~~ ~j; ~ ~' 9 S P 1 ~ 5 state WA fRRANTY DEED 2003 Document Number Document Name THIS DEED, made between Michael J. Spencer, a single person f"Grantor," whether one or more), and _~lerle,.,~. ast, a mazried ne~nn ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property"} (if more space is needed, please attach addendum): Lot 13, High Meadows, Town of Hudson. Recording Area Name and Return Address Title One Premier Group, Inc. ?06 19th Street South Hudson, Wisconsin 54016 020-1146-90-000 Parcel Identification Number {PIN) This is not homestead property. (is} (is not} Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: 12oadways, Easements, and Restrictions of Record. Dated hlove3nber, 2, 2004 (SEAL) _ ~ (SEAL) *Mi el J. Sp cer AUTHENTICATION (SEAL) (SEAL) s ACKNOWLEDGMENT STATE OF WISCONSIN } } SS. St. Croix COUNTY) Personalty came before me on PTovamber, 2, 2ooA , the above-named Michael J. Spencer KATHLEEN H. MALSK REGISTER OF DEEDS ST. CROIX CQ. , WI RECEIVED FOR RECORD 11/15/2004 01:15Ph MARRANTY DEED EXEMPT 1{ REC FEE: i1.00 TRATIS FEE: 2b1.00 COPY F&E: CC FEE: PAGES: 1 Signature(s) authenticated on IwY v. 'T'ITLE: MEMBER STATE I3A~ ISCON ~ to me known to be the person(s) who executed the (If not, ~'9T ~~' ~<' , foregoing instrt3t~nt and acknowled ed the same. authorized by Wis. Stet. § 7 '.bg~~~•r~~~~~ THIS INSTRUMENT DRAFTED B": `~ Michael H,_ Forecki, Attorney Notary ic, Slate of Wisconsin Eau Claire, Wisconsin My Co fission (is permanent} (expires: 12/12/2004 ) (Signatures may be setheaticated or acknowledged. BotA are not accessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THOS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1-2003 *Type name below signatures. Attorney i~tichad H Focecki 3452 Oakwood 13itln P3cwy Ste 1, Ew Claire W[ 54701-7928 Phooe~. {7! S) 835-3029 Fez: (7!S) 835A1 l2 T5329786.ZFX 'T'itle Une Premier Grout' Produced with 7lpform"' by fiE FtxmsNet, LLC 19025 Fifteen M8e Road, Clirnan Township. MucApan 49035, (800) 399-9905 y~ ~~~~5 t~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner yer ~~'--~ ~ ~"" ~ u a .~.~.~ ~ ~ IZ L L~ .~i4ST .. _, n ~ i Mailing Address properly Address City/State 3 ~ (Verification required from (-v i ~~ of for new Parcel Identification Number D Z ~ _ ~~4~(0 ~ %~ CSC LEGAL DESCRIP~T, IO )N / property LVcatton`~ `'~ 1~4,~`_ 'I4, Sec. ~'° SubdiV1S10II 77~ T~N-R~W, Town of LVt # ~. ~ ~ Certified Survey Map # ~- .Volume ~~ . ,Page # Warranty Deed # ~ ~~ ~~ .Volume ~ Page # Spec house ^ yes~o Lot lines identifiable~es ^ 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 throe years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastCrplumber, journeymanplumber, restrictedplumber or a licensedpumperverifying that (1) the on-site wastewaterdisposal 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 of the three year expiration date. /~i ~iD SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of e perty descnbe above, by virtue of a warranty deed recorded in Register of Deeds Off ce. \`° ~a SIGNATURE OF APPLICANT DATE ***s** 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 FROM :ATLAS CONSTRUCTION ~ ~~ N~,~ r. 1i e.n N /b 1 I I I I 1 1 1 1 I I 1 1 1 1 I 1 1 1 1 ~~-~ 1 I 7 1 1 1 1 1 7C.0" 1 1 I 1 V 1 1 I I J N.I17N:77t7 ' ~"" '" ~ -a 7MM 17.1•M1 7Mre ~ 4 de b HARLSUNS ~;~ ~ ~ ~l-~ °~',~' mot. ~,tldM iK4 V w.... r pp eo! Ve1MInpMdM17~IMYrni 1i11u Chhe. W1517~1 NwNA>`: ~aat Builde!'B 11whMlr: t7-bIN tzsw 1111111w.111~If.ItM14d. Ilr~lllraul a+.n.a.r L~1~LD~10lD~ICAtfI~ tlllgl!(77~~1~~lM . 6~ -.sl~lw~e 7Va711 RAX (771 Y3a.1111i t.Mttlihr. ` FAX NO. w•.u^ Dec. 13 2004 05:11PM P7 I tsa trr 1 1 ~ *_amcnxls I Y M 1 I I 1 i ' ' I I i 1 1 1 _ ~g 4F I 1 1 I 1 1 1 1 . - `~-----'-__---• ' 1 . 1 1 1 1 1 I 1 1 ~ I 1 I 1 r I ~ 1 1 1 1 1 I i 1 ; - a ~ . = ~ I / ~ 1 ~ I I I 1 1 1 ~~. \ V p F• ' I ~,~ I 1 y y M. 1 1 ~ • 1 1 ~ ' 1 ~~ i I~ y {`y I J. J 1 ~ J = 4 M 4 W 1 I O I Ip'. 1 1 b ~ - r •( 1 1 w i, I I y L 7 i w FI 3 + P ! : / ~ ~ ~ ~ ~ ~ 1 p ~ 4 FF M g 1 , T. ~ 1 4 r~~ 7~a• r - ---- ~--- - rr 4~ 4 ~ p ~ 4 a• a k su: ur S'~ V7" Dec 14 04 08:21a 1 - ar-u- `~ H N :~ C a cn -e M y ra•a~ xr-e^ prftv~s ~ a ~urtc ~" vO < - ls7 0 C.I ~ ~ ;Y A ,~ ~ 7 ~ '` a= t b € ~ ~ ~ ~" i r _ c a4i S y ~ F ~_ t r0, ~ . .I R'aY F-0n p K ~ ?'4' Y-e t « ? ' ~ f i 11 } 7 q . _ ~_ 3 ~ w 4 _ ~ j _ - /~: ~iw ~°' iY t a~ ~ --- , ~ , . ~ "~ I 1 ~~ ro ~ ~ •a- d mw i C'J-^ ~D ifi• 1 i _ : I_ 6= ? I a I ~ c a G ,r+ ? _ r~-6 ~ 'ti R F 12 l . 1 a _ _ ___~ O o~ Ir1.0^ y ej 3 ~ ~ 3 - 4 _ _ :•-~ =s ur r Q ; r 9 "~ ° ;m.n• a.rr _ ~~. o ~; u r, 9 U= ..~ jN b ~; . '= pO M y :P FInY.:2t12 urct2-t-u4 ne.p.o,m.~~.orr,.. HARLSONS ~'""~' ~''°'~S"~ sear v.. 2.rJ v.naaw^..rna...,e.,..a r.O.Bac74R Qr1"fi1.O: ~:-tai aingmRae.l,h! Ear Cirirc. wl 54762 r2-7a1 a,1.nNrwy.tm.v.p+,r. $1~DH~I(3~DffiiI$IICffir117~ Plwselllc)Ki5-9t~1 s~ ¢.hbbllcu re26 nR}p.sF.~:CoteResideBee s.an e.•: Bast BnOdt:rs FAX (7L;) 635-1641 Lrttrin: p.l FROM :ATLAS CONSTRUCTION FAX N0. Dec. 13 2004 05:11PM P5 D L7 D ol~a .~~. t~o4 caon ~~ i as flfl Q~ .[i.t~ilL-7~1~ ~.7 nwelH.ewe.f~ ar1~.e1w, Cah Rwiideace .. ru, ff.. ~o ~~~ tu~.cffr.wff~ma 1~IIp BfIfltBppdety .. . ~~ 17f3lK1S61M B~MfaNMnf (full FAX (71S) IIl~11H1 1sraNnn~ - . FROM :ATLAS CONSTRUCTION FAX ND. Dec. 13 2004 05:12PM P8 ~~i 1 .......~___~~~---- ~ u~av 's 1 ~_ . ' ....... ..... -- - ~.._......«......,... ~ ~__~__. _. _._._ R ~O b od :. „ 1 ~ 1 ~ ~ > ~ ~ ~ ~ ~ 1 (.~{ T ! 1 A e ~ ~ • ~ ~ ~E q r 1. • n .x• 0' b ~, i t _ i ' ~ 1 11'-F' ~. `Y I r u'.m .,p, . .. .. .. .. .. 1 ~ v w aim .DATED THIS 5TH DAY OF MARCH 1.979. REVISED THIS 5TH DAY OF MAYS J979. ~ FUTURE DEVELOPERS EXTEND THE ROAD TO THE WEST, SUCH DEVELOPER L BE RESPONSIBLE FOR OBLITERATING THE EXISTING CUL-DE -SAC, CONSTRUCTING: ROADWAY IN ACCORDANCE WITH COUNTY STANDARDS AND RECONSTRUCTING 66' DRIVEWAYS WHICH HAVE BEEN DISTURBED. NEITHER THE TOWNSHIP NOR S 89° 37'22"E CENT PROPERTY OWNERS WILL BE HELD LIABLE FOR ANY COSTS INCURRED ~ ONSTRUCTING THE SAME. ~O p I 's. O O o~,~ x ~ S 89° 37' 22" E 440.00' o ~ .'°~ M 90 0 -I~ W ~9. o" I O 0: o,~,, 9 ti ~ I I ~ ~ N lei 3 2.058 AGI O !4 M 12 W n I N 2.261 ACRES INCLUDING CUL-DE-SAC j~ 'I 2.120 ACRES EXCLUDING CUL-DE-SAC _ O z 1 d- I N88°OO~E ~_ ~, '% Z ~. 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