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Home My WebLink About026-1294-03-000 Wisconsin Department of Commerce ! `! County: PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division �. INSPECTION REPORT Sanitary Permit No: 487967 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: , / 2> Richmond Acres LLC Richmond, Town of 1Q — `7 "'G�Gf.� CST BM Elev: Insp. BM Elev: BM Descriptio Section/Town /Range /Map No: !�'1 28.30.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic _ Benchmark Dosing h Alt. BM �lJ l� Aeration Bldg. Sewer -/ `7 Holding S t Inlet <� /' 7 /; O i SVHt Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic IJ G� Dt Bottom U 15--r Dosing > 35 Header /Man Aeration Dist. Pipe C Holding Bot. System /� -7 t Final Gra e PUMP /SIPHON INFORMATION [/' l(i'Q, } '�ti` � iti11'IG�' r` U Manufacturer Demand St Cover GPM Model Number TDH Li • O Fri 1 (. Loss System TD Ft 2L Forcemain Len tFy Dia� Dist. to eIT- I 1 / /�_ '1 S 6 r/ E7 ors > 5 � o� - Jl�a *X_ SOIL SOIL ABSORPTION SYSTEM BED/TRENCH Width , t Le et hy IN6. Of Trench s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS i 1 SETBACK SYSTEM TO P/L tJ JBLDG IWELL LAKE /STREAM EACHING Manufac INFORMATION CHAMBER OR , Type Of sl / :� + �� UNIT; Model Number: G DI M BUTION SYSTEM �HeaderjMeinifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipes) J � ngth Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over n Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center G Bed/Trench Edges Topsoil -1 Yes No Yes f COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: r� Inspection #2: / / Location: ? 160th Street New Richmond, WI 54017 (SW 1/4 SE 1/4 28 T30N R1 8W) Richmond Acres' Lott 33 Parcel No: 28.30.18. 1 1.) Alt BM Description = � � (� �'✓Gi� 2.) Bldg sewer length =+�' - amount of cover = > y F Plan revision Required? L Yes L: � No Use other side for additional information. Date Insepctors ignature Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County �p,� 201 W. Wash' Ave., P.O. Box 7162 Gw�k,.7( i seonsin M disc , 53707 - 7162 Sanitary Permit Number (to be filled in b Co ) Department of Commerce (6 8) 266 -3151 Sanitar Permit A li a O an I.D. umber Y PP RECEIVE In accord with Comm 83.21, Wis. Adm. Code, personal in rma u provide may be used for secondary purposes Privacy Law, 15. xm) Projeo Address (if diffitrant than mailing address) 1. Application Information - Please Print All Information lf.vh � s otu P ,poperty Owner's Name 7K 1\ L ZONING OFFICE Parce # Lot roperty Owner's Mailing Address Property Location �D 1 l 6 0 P, 6V Vii., /., section City, State �-+ /�/� Zip Code 2/� Phone Number }� /� /,�, , L� G �1 �5 tJWI�t -� 'V T �VN; R �� Eo e p 0�lr9 70 II. Type of Building (check all that apply) 3 ` .y l Q� y` • � or 2 Family weedroom s Subdivision Name CSM Num r ❑ Public/Comtn�i V_V A � 14 / ❑ State Owned es ribe �5 ❑City_❑VillagAT wnship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. �"`ew System y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B. ❑Permit Renewal ❑Permit Revision 11 Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner W. Type of P OW TS System: Check all that appl A.Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland El Pressurized In -Gr d El Holding Tank El Peat Filter El Aerobic Treatment Unit El Recirculating Sand Filter El Recirculating Synthetic Media Filter Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Informs / Design Flow (gpd) Design Soil Appllion Ra e(gpdsf) Dispersal Area Required (sfj Dispersal Area Proposed (sf) System Elevation 4 5 /I Z� /• '?7. G VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank ` Aerobic Treaunem Unit AX Dosing Chamber 116do I j I VII. Responsibility Statement- I, the undersigned assume responsibility for in ron o POWTS shown on the attached plans. Plumber's Name (Print) I Plumber's S' ature PRS er Business Phone Number PI nber's Address (Street, City, State, Zip C e) �U • � �6�' pis s�� W �"4 R VIII. unt /De artment Use Onl Approved El Disapproved Sanitary Permit Fee includes Groundwater Date Issued 1 mg Agent ure S mps) Surcharge Fee) 2 El Given Reason for Denial W1'✓ VV i 2 Q Q I9'.YGiEtti611@,Jp}'g$proval /Reasons for Disapproval � l� /�- 1 Septic tank, effluent filter and dispersal cell must all be serviced I maintained as per management plan provided by plumber. All setback re uirements must be maintained n / i�/I _ 1 /� / -,A .A � 7 � �i 4, -V [� N � c ^' NO - T ti :�r N > I f /\ 7 tA Q W 1 --4 CAJ a D BID- o Fj C C; p m 17 C� �a z tN C3 't7 � II II O' fi -SI N \ • j cz 1. O G o rA a � 9 O H N � Ul N ` I �� o ® �, �p PIZ N I�A D � rti G N F tDnl Q co cx� CA FZ rt t w p cT s► Page Of COMBINATION SEPTIC TANK /PUMP CHAMBER (No Scale) 4" CI Vent Pipe with Approved Locking Manhole Cover Approved Cap, +25' With Warning Label Attached From Buildings � Weatherproof Approved 1 _ Warning Label Junction Box . Vent Cap -� 12" mum Final Grade 6 Minimum 4" Minimum 6 Maximum ' L4" 4 C.I. ' 18" Minimum Insp. Pipe __ nect Weep Baffles ' � Approved Joint w /C.I. Pipe i A Extending 3' 1 Alarm B Approved Joint Onto Solid Soil On 6, w /C.I. Pipe C Extending 3' Onto Solid Soil Off 6' L7 D Conc. Block 3" of Bedding Under Tank--" Note: Pump and Alarm Are On Separate Circuits Number of Doses: Per Day Gal l ons Per Day /F - Doses : Gal `1 ons Volume of Backflow:.......+ ,7 GaTbons Tank Manufacturer: WIEZr-k Total Dose Volume: ........ ,7 Gallons Tank Size - Septic /Pump: Gallons Alarm Manufacturer: fF�RQ(N j0 S Model Number: N\-� 250 Capacities: A t inches or 6Gal1ons Swi ch Type • l) P + B nches or 3` Gal -1 ons Pump Manufa cturer �b�l1El� + C or i Gallons Model Number: .1J. + D /O inches or Gallons Mini Discharge Rate. Total ..... inches or Gallons Vertical Difference Between Pump Off and Distribution Pipe: Minimum Required Supply Pr ssure ..........................+ — Feet {20 Feet of Force Main x l ,59 /, Friction Factor /100 Feet: + eet Z Inch Diameter Force Mai n Total Dynamic Head:... _ 13 9'3SFeet Internal Tank Dimensions: Length Width Liquid Depth_ Signatu License Number 2Z32 Z Date �� n TOTAL DYNAMIC HEAD /CAPACITY w HEAD CAPACITY CURVE PER MINUTE L�J � MODELS 53/55/57/59 EFFLUENT AND DEWATERING 25 Model 53/55/57/59 6 20 0 Ft. Meters Gal. Ltrs. 5 1.5 43 163 15 10 3.1 34 129 4 r 15 4.6 19 72 0 a 10 Shut -off Head 19.25 ft. (5.9m) 0 2 5 3 15/16 6 5/32 — 4 5/8 1 1/2 —11 1/2 NPT 0 U.S. GALLONS 10 20 30 40 50 LITERS 3 15/16 0 80 160 � _ FLOW PER MINUTE OM97 4 1 /16 CONSULT FACTORY FOR SPECIAL APPLICATIONS 1 1 • Variable level float switches available. • Variable level long cycle systems available. • Available with special cord lengths of 15', 25', 35' and 50'. • Alarm systems available. 10 1/16 • Duplex systems available. 3 3/32 SKa58 Single Seal Control Selection Listings SELECTION GUIDE Model Volts Phase Mode Amps Simplex Duplex CSA UL 1. Integral float operated mechanical switch, no external control required. M53155 & M57/59 115 1 Auto 9.7 1 — Y Y 2. Single piggyback variable level float switch or double piggyback variable level N53/55 & N57/59 115 1 Non 9.7 2 3 or 4 & 5 Y Y float switch. Refer to FM0477. BN53 115 1 Auto 9.7 — Y y 3. Mechanical alternator "M - Pak" 10 - 0072 or 10 - 0075. BN57 115 1 Auto 9.7 - N Y BE53r57 230 1 Auto 4.8 _ y Y 4. See FM0712 for correct model of Electrical Alternator. D53/55 & 057/59 230 1 Auto 4.8 1 -- Y Y Y 5. Variable level control switch 10 -0225 used as a control activator, with Electrical E53155 & E57I59 230 1 Non 4.8 2 3 or4 & 5 Y A ( ) or ( ) float Single piggyback switch included. A CAUTION For information on additional Zoeller products refer to catalog on Piggyback Variable Level Float Switches, FM0477; All installation of controls, protection devices and wiring should be done by a qualified Electrical Alternator, FM0486; Mechanical Alternator, FM0495; Sump/Sewage Basins, FM0487; and Single Phase licensed electrician. All electrical and safety codes should be followed including the most Simplex Pump ControVAlarm Systems, FM0732. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 Louisville, KY 40256.0347 Manufacturers of . . O SHIP TO: 3649 Cane Run Road ® Louisville, KY 40211 -1961 QOd[ /TYPUMPS 91*CE /9,79 o PUMP !O. (502) FAX (502) 773624 PUMP h ttp: / /www.zoeller. corn 0 Copyright 2002 Zoeller Co. All rights reserved. � _ W Od 25 05 08:32a JEFF FOX 17157552484 p.2 ST. CROIX COUNTY SMMC TANK MAINTENANCE AGRMW ENT AND OWNMHIP CERTIFICATION ORM Ow=/Buyer Mailing Address 9d TH WE' • K ELK RIVCIZ, MO .5S Property Address YA.eJ (vCifflcation reTAMd from Planing & Zoning Dtparmaeat fer new chi ucdM) j City /State _ Identification Number LEGAL DESCRIP'T'ION Property Location 1 /. , SE Y� , Sec. Z8 T .'s U N R J�W, Town of �1Cft n , Subdivision 4 S — 6L62:1 EM , Lot #�� Certified Survey Map # , volume Page # &JAIZ3 z k�d # , voiurnc .S� Page # '7 Spec hove (yes) no Lot hrm idendfable y no US= MAI'MNANCE AND O CERTIFICATION Improper use and maiatenwice of yow septic system could result m its premature ature faihtre to handle wastes. P:Wer mmntm=c consists of piawpmg out &e septic tank every three ye= or sooner, if needed, by a l C=Wd pumper. What you put into the systtrtt can affct the !unction of the septic tank as a t eaatteust stage in the waste disposal system Owner mamdanancc responssbnitias are specified in §C.otmm. 83-52(l) and is Chapter 12 - St Croix C,autiy Sanitary C)rdirsnoa lie property ow ag row tQ submit to St: Croix County Plasm Wg & Zomittg Deparl� nag a omtiflcat m form. signed ner by the owner and by a master ph=*er, joutryman phmtbea, vwtzictod phtmber or a licensed pumper verifying that (I) ft 00-ate wastewattx disposal sysxm is in proper operating condition md/or (2) after iaspecaon and pumping (if necessary), the septic tank is I= than, 1/3 full of sludge. d ..,.,�.`� �spo6at Uwe, the undemgMed haw and the above rCCiwcments and agree to naamum the private sewage system wrtlt the standards set forib, herein, as set by the Depa r0oareent of Commerce and the Depa bvcW of Nattual Resoeu+ces, Sate of Wbco=pu. !axed and retaarued the St Croix & C,moa stating tat your septic sysoeaa has been lnaialx►zned must be completed County $ Zoniag Deparnm , n within 30 days ofdo throe year expiration date. V%ve certify that all stastwenn on this fomt are true to the best of my /our knowledge. Vwe am/m me mm(s) of the property described above, by virtue of a warranty deed recorded in Register of Acee Office. Number of bedrooms l0 STGNA OF APPLTCANT(S) DATE ***Any infot =W= that is misrepresented may result w the samitary pe unit being revoked by tltt Plaeming & Zoning Dapsnrtmte:nt «•« Include with this application a recorded warranty deed fiomt the Register of Deeds Office and s copy of the eextified survey map if referaaco is made in the warranty deed. ('REV. Od 25 05 08:22a JEFF FOX 17157552464 p.2 ST. CROIX COUNTY RECEIVED SEMC TAM MAINTENANCE AGREENOSM AND OCT 2 6 2005 OWNERSHP CERT,iFICATION FORM Oww�BuyCx ='R 't.l� l� rc /Yl0 U6 ST. ZQUI OFFICE Maims Ad&ess 11 I h 1 �� T H VC IV• W CtK R &R. M 1� SSA Property Address (Verification required from Planning & Zoning Department tar new comuucb m) city /State Pamel Identification Number L LEGAL DFSCRIMON Property Location %. , SE V4 , Sec. 8 T 3 0 N R 1 W, Town of Subdivision v l ' WS , Lot # _3 Certified Survey Map # � � Volume Page # Warranty Deed # , Volume , Page # Spec house yes no Lot liar idendfleble yes w SYSTEM MAl' UNANM AND OWNER CRATMCATTON lte�ropar use and mWnWomzice of yow septic systm oould result in its presmtM Wwe to Kandla wastes. Proper maintmame consists of puxtpiunyg one Se, septic tank every three years or sooner, if needed, by a limsed pumper. What you gut into the sysm can &ffoa the function of ft septic t wk as a trasonew stage m the waste disposal system Owner mam*nance tespomflu it"es are specified in §C.omnm 83.52(1) and is Cboptw 12 - St. Croix County Sanitary 0"UO nce. The property owner agrees to submit to St arm County Plaonai os a Zonimg Dep� a Car060"n tiro, signed by the owmar and by a mast= photim, jonawym m phrmbea, tesuicted phmkw or a licensed pump= verifAW 64 (1) due etc wastewater disposal system w m proper epastaag condition and/or (2) after mpecton and pmoapmg; (if ne y), the septic tank w less than 1/3 full of "p. Uwe, the undersigned have and the above regwemenm and agree to mwi tm the private sewage AVOW system with the stsodar a set forth, herein, as set by the Dcpuu u= t of Commerce and the Departmaa i of Namtal kesou rces, State of WiscoAXin. Cartiftsu a stating that your septic system has been wed =cat be completed and wWmed to the St Croix 0=1tY P'laa m$ dt Zooms Depwbn=t within 30 days of due Herne yeast expiration date. ltwe certify that ail stated on this faro are true to the best of my /our knowledge. Vwe ad= t1e owner(s) of the property des=jx4 above, by virtue of a war auty deed recorded w Register of Deeds Off" Number f bedrooms ` io /as/ 05- STGNAT ME OF APPLICANTS) DATE ***A is bMat m dust a ==pr red may result in gn sanitary pemtit bewg revolted by the ftwing & Zomag Department. R `* 'bxbm a with this application a recorded waaw.ty deed from the Register of Deeds Office and a copy of the oa bfW swvey map if r 1mmee is made in the warranty deed. (RZv POWTS OWNER'S MANUAL & MANAGEi� MT PlA11i . p age lJ. Tloill ,L� sYS sca�oas EXAM t1!hirner -. 5 Z,Z Septic Tank capacity' Peark # 8 a( - ❑:AtA- Septic Tarok Manufacsrf - ❑ NA Dll PARAMEf81S Effluent Filter Mangy -LAW ❑ NA f+ltfr�`nbel of Bedrooms J . DNA Effluent RW Model 11 — p 7Z I� NA % '4` " of -Public Facility Aktits $I. NA ' Pump Tank Capacity b6b 9el O NA flow- (average)- .3 gaud Pump Tank Manufacturer u j 13 NA D26 flow (peak). (Estknated x 1.5) �� al/day Pump Manufactumr Z ❑ NA Soil Rate y gat/dayft' Pump Model . . S3 NA StaAdaed kAuegVEf&xxnt Quality Monti*average# Pretreatment Unit ANA Pats, ON & Grease (FOG) 530 mg/L ❑ Sand/Gravel Riter ❑ Peat fir WOChemicai Oxygen Demand (B.OD�) <...220 mg/L ❑ NA ❑ Merhanicai.Aeration ❑ Wetland - Total Suspenderd Solids (TSS) 5150 mg/L ❑ Disinfection• ❑ Other: Pretreated Effluent Quality- - y Miinthly average Dispersal Cell(s) p HA l3iochemecal Oxygen Demand JBOD 530 mg/L in -Ground (gravity) Q In-Ground (P�rEted) Total S s [TSS) :530 mg/L ANA .❑ At- Grade- ❑ Mound Fecal- Coirfoan (geometric in a) 5 100ml ❑ prip -fie ❑.Other Maidmum Effluent Particle Size I< in dia. ❑ NA] Other: ❑ NA Other: Other. • ❑ NA ❑ NA "Vakes typical for dmnestic wastewater and s;j tank efftaert Other ❑ MAIN TENAXCE SCHHXULE - .Service Event Service - >nspect condition -of tank(s) At least "once every: ❑ ye montti(s) (Maxirtunn 3 3 Z ars) A years) ❑. NA . Pump out contents of tank(s) When combined sludge -and scum equals one -Wad %) of tank volume ❑ NA .Inspect dispersal cents) At' least once every: ❑ months) (Ma)cittsrrrr 3 ye�sl ❑ NA years) Clean effluent filter S t least once every: E3 this) ❑ NA InsPect pump pump consols & alarm At least once every: ❑ •month(sl ❑ NA t Year(s) - Flush laterals pressure test At least once every: ❑ rnanthts) ❑ year(s) NA Other _'At least once ev ery: month(s) ery ❑ year(s) NA ❑ NA MAiNT8MKCE. INSTRUCTK)W ktspections of tanks and dispersal cens ,shah be. made by an individual carrying one of the foUgwing licenses or certifications: Master, ' Plumber Master Plumber "Restricted Sewer; - POWTS inspector; POWTS Maintakm�; Septage Servicing Operator. Tank inspections must include a. vistial •irmpecdon of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scam and to check for any back up or ponde?g of effluent on the ground surface. The drspersal cW(sl shall be visually ahspected to check the effluent levels in -the observaiion'pipes and to check for any pondahg of effluent on the ground - surface. The pondng of effluent on the ground surface may abdicate a falling condition and requires the ftnediate noffeadw of the local regulatory authority. When the combined eccumulation of skrdge and -scum in • airy tank equals of the tank volume, the entire contents of the tank a 5ervicabg Operator and disposed of- in accordance - NR 113, W istrative Code. other services, inch f but- not Waited to the servicing -of effluent filters, mechanical or pressurized a mpone Tm, prevea t any servicing at intervals o <12 -shall be performed by a certified POWTS Maintainer. A service.report authority within 10 days of completion of any servi Gegw waear r if UP AND OPERATION won, Prior m use of -the. POWTS . Treatment tantW for the Wmence•of may impede the tr+eRtmiertt Process• and /WdamV the ceW. ff m9h P Products -or a�.� b y a g - paw use. -are detected havve.the.mr� Sys start up shall not occur when.soil conditions are frozen at the infkrative m During Power outog� Pump tanks may fill above rio nal Lirghwater ievels: When d ged to the d sal cell(s) • in one urge .dose, overloading the cer and power is restored the excess `^�ewa�tet. wig be effluent.- To avoid: this situation have the contents of the pump tank removed a result, in the backup of StI face discharge- restore not a Pump Or �= a or POWYS lulaintairner to asst e 9 Operator prior to restoaing Levels within the Pump tank �'" o •PwItig the PuMV controls to Do-not drive over tanks and d cells. Do not drive or park over, or other ro . disturb � � the area within 15 feet.down slope of any mound or at -grade sod ar absorptioFl ea. Reduction or elimination of foltowing from the wastewater stream may POWTS.- antibiosacs;- baby wipes; �Sar butts; cgndoms cotton swabs; move the d f loss and prolong the fife. s; the frxaidation drain !sump PumP) water, fruit and vegetable - greas, er dental floss; diapers d fectanis; fat products; Pesticides; sari gasairne; grease: herbicides;. meat scxaps; med-0ons; oll; naPkk=, tampons; and watei, softener brute ASMDONMENT When the POWYS falls- an is PerMaFxmtly taken out of service the following st fly and safely abandoned in compliance with chapter Corms 83,33, Wisconsin Admiristradve Code: assure that the sYssern is All Piping to tanks and Picts shall be d'rsconfx=Ted and the abandoned pipe - openings sealed . • The contents Of -2111 tanks and its snap . P be removed and property disposed of by a Septa Servicing operator. • Af ter—Ping, all tanks and pits shall be excavated and removed or their c' vecs so removed and the void space with d, gravel. or another in ert solid material CONT94GENCY PLAN re mant- p�nesrt the - S fails system: re and cannot be repaired the following measures have Been, or, must be taken, to Provide a code comp . liam - system. The -r area has evaluated and may be utrT¢ed for the bcation of a rePt t ( eP�ent area should be protected from distwerc bce and co absorption required setbacks from existing and pro str ms and should nat.be a+nged. upon by result in the need for a new Posed ucture, lot .Tines and welts. Failure to protect the replac a will soil and site evaluation to establish a suitable replacement area, Replacement system o mply with the rules in effect at that time. must CI A . suitable replacement area is not available - due to setback and/or sol limitations_ ga d1ku Tec hnology a holding tank may be. installed as a last resort to re ro^9 advances in POWYS place the faded POWYS_ . been - a ed to -id t area. U m be Pe ed e a su suitab P� f of the POWYS a soil and site � rrt f no re ant vac �� ast. r'esoR � reRlace the faded. POWT$_ . ❑ Mound and at -grade sod a�tlstion Sy - infiltrative ve surf a stems may be reconstructed in place following removal of the bkxnat at the e� of such systems must comply with the rules in effect at that tine. < <WAMONG > - SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT !ALTER A - S6'1 7C, PUMP OR OTHER TFIEATi.MENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE lNTI30013 OF A TANK MAY - 8E DIFFICULT OR IMPOSSI ADDITIONAL COMMENTS fOWTS MtSTA r ER POWYS M/> WAWH4 Name � Name Phone Phone SEPTAGE SERVICING OPERATOR {PUNIPH;I LOCAL REGULATORY AUTHORITY Name Nam 01 Phone.: �rt ekxw zv Ni ►� b this docurr,em was b ilia - � in - e 8b. wrdt c#tap[er Comm 83.22 (f(Z ) (d}&tfI and & U 2851 P 0?? 801423 �? State Bar of Wisconsin Form 3 -2003 KATHLEEN H. WALSH QUIT CLAIM DEED REGISTER OF DEEDS ST. CROIX CO., WI Document Number Document Name RECEIVED FOR RECORD 07/26/2005 10:00AN QUIT CLAIM DEED THIS DEED, made between Gerald J. Smith and Jeannine B. Smith, husband and EXOPT # 18 wife REC FEE: 13.00 (" tor," whether one or more), TRANS FEE: An Richmond Acres LLC a W' cousin limited liability company COPY FEE: CC FEE: "Grantee," whether on re). PAGES: 2 Grantor quit claims to Grantee the following described real estate, together with the rents, Recording Area profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is needed, please attach addendum): Name and Return Address See attached Exhibit A Kristina Ogland Attorney at Lw P,O* Box 359 Hudson, WI 54016 026- 1082 -40- 000 :026- 1083 -10 -000: 026 -1082- 70- 000.026 -1082- 40-000 Parcel Identification Number (PM) This is not homestead property. Dated (SEAL) (SEAL) erald J. SnA i eannine B. Smith (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on STATE OF t/UISOL'o 1S/ rA ) ss. ' I�IX COUNTY ) AKA TITLE: MEMBER STATE BAR Of04 Personally came before me on (If not, e above -named Gerald J. Smith and Jeannine B. Smith. authorized by Wis. Stat. § 6. Le usband and wife o me known to be the person(s) who executed the foregoing THIS INSTRUMENT DRAFTED B instrument and acknowledged the same. Kristina O land Estreen & land srATE� � ��- 304 Locust Street, Hudson, WI 54016 Notary Public, State of My Commission (is permanent) (expires: 9�5'b5 1 (Signatures may be authenticated or acknowledged Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. QUIT CLAIM DEED 0 2003 STATE BAR OF WISCONSIN FORM NO. 3-2003 * Type name below signatures. INFO -PROTM Legal Forms 600.655 -2021 wwwJnfoprofoans.00m U 2851P 078 EXHIBIT A P�ce11 The East Half ofthe East Half ofthe Southwest Quarter (El/2/El/2/SW1 /4) of Section Twenty Eight (28), Township Thirty (30) North, Range Eighteen (18) West, Town ofRichmond, St. Croix County, Wisconsin. EXCEPT Lot One (1) of Certified Survey Map filed April 24,1990, in Vol. 8 ofC.S.M., pg. 2199, as Doc. No.15"78 mg part of the Southwest Quarter of the Southeast Quarter (SW 1 /4/SE1 /4) and part o£the Southeast Quarter of the Southwest Quarter (SE1 /4/SW1 /4), both in Section Twenty Eight (28), Township Thirty (30) North, Range Eighteen (18) West. Parcel 2 The West Half of the Southeast Quarter (Wl/VSEl /4) 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 April 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 (SWl/4/SEl /4) and part of the Southeast Quarter of the Southwest Quarter (SEl /4/SWl /4), both in Section Twenty Eight (28), Township Thirty (30) North, Range Eighteen (18) West; 2. Lot One (1) of Certified Survey Map filed 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 1 /4/SE 1/4) of Section Twenty Eight (28); Township Thirty (30) North, Range Eighteen (18) West; 3. Commencing at the Southwest comer of Lot One (1) of Certified Survey Map filed August 13,198 1, in Vol. 4 of C.S.M., pg. 1093, as Doc. No. 372738, for the point of beginning; thence N89 1 59'15" Wiest 20.00 feet; thence N0 °01'41" East 262.00 feet; thence S89 0 59'15" East 224.00 feet; thence SO °01'41" West 15.00 feet; thence N89 °59'15" West 209.00 feet; thence SO °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 (NW1 /4 /SE1 /4) 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. Wisconsin De of Commerce EJ EVALUATION REPORT Page __ of Division of Safe and Build s ry g � r ante with Comm 85, Wis. Adm. Code County S 1 C O I Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal re Parcel I.D. percent slope, scale or dimensions, north arrow, an iocati i arest r ad. Please print all info mation. R awed b Date Personal information you provide may be used for second purpoApj(ivggy Property Owner Property tion Ge�a� ' C -� ST.CROIXC YLot W 1/45E1/4 Sa$T30 N R E(or Property Owner's Mailing Address ock # Subd. Name or CSM# - Al 90 e. N W M at o F .c m Ac City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road 30 ( - Tg il �,►ch r �� S'fi' [9 New Construction Use: [15 Residential / Number of bedrooms _ Code derived design flow rate s� __ GPD ❑ Replacement ❑ Public or commercial - Des Gtita / , �bl - Parent material �ja,�. �T � t y (; (J B FI d PI in e.eva i n Ica e T General comments .�Sv�e S -f 3 = T3�rf t.�►� S t.4� FO r' Pr•t n. wry ♦ t/- 'fit - Lrc� S C •y� f uv' T h• and recommendations: � rt � a e.e..�•. e. 1r�►w;11 10c T y t T.98,Do 'T•1 97.(00 - %3 Boring # 1 El Boring 54 Pit Ground surface elev. 1W 00 ft. Depth to limiting factor —in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0- O y(Z 3� L s 2ms)nL wi r a - y �_...._.... v- w IF 3 a 9 -S S Y L 4 1 (, — .�._ s L r Gw I V E i. - - 5 Fr o /W v)- CIO 7' no t It -I, -7 F 2 ® Boring # n Boring R Pit Ground surface elev. I , O 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#? to 4 S y S o tom, 7 S Y9 9 /6 . d- 1 -- -- _._. vyt Effluent #1 = BOD > 30 5 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L T Name (Please P Signature CST Number a.,r1t ZI Wk tz � ',CA — Add * k .1 Date Evaluation Conducted Telephone Number 'r ' �'; a - 7 -6 715 -d V8 359 bib WM syD I v G era 1 � S m Ak Parcel ID # Page GR _ of F,-31 Property Owner �_ — P riY Boring # E] Boring Q Q P • pit Ground surface elev. _! 7 �� ft. Depth to limiting factor �S in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 o -� Y a 3 L la6L nn Ey- A a , 9 JO 11 - 10ya S L ✓ LW , ca y M uy 1 v I q y es . yl - Z F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Awlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fY In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a Boring # ❑ Boring _ ❑ Pit Ground surface elev. _ ft. Depth to limiting factor in. Soil A lication 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 • - > < Effluent #2 = BOD < 30 m Land TSS < 30 m Effluent #1 - BOD > 30 < 220 mg/L and TSS 30 _ 150 mg/L a _ 9/ 9/ 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•9330 (RAM) s � 1 , TvP NE cor►��r ��Fe ! Svr�� : pe d► To P SE carrer Si•� <1 Sv.tutY .�} �Z _- - L v •• 91 3 1 _ - cr At cl I - 1 __ __ __ _ _. __ __ ___ __ _ __ __ __ _ __ __ __ _ _ -_ _ _ ____ __ ____ __ __ __ __ __ _ ____ _____ __ ___ __ _ ____ -- .. __.._....... __ __ __ __ -_ __ - _ _ _ __ -_. __ _ _ __ __ _ __. __ __ _. ___ __ _ __ __ _ _. __ __ __ __.. ____ __ - _ __ __ __ ___ ___ ___ __ __ __ __ _ ___ __ _ __ - _ __.. ___ ___ __ _ -- __ - __ __ __ __ __ _._ __ - _ _. __ __ - -- __ _ __ __ _ __ __ __ __ _ __ __ ___ _.__ __ __. ___ __ -. __ __ - _ __ ____ __ __ _ ___ _ __ __ __ __ __ ____ __ _ _ __ - ___ __ __ __ _ -_ __ _ _ __ __ __ _ _. __ __ _. _ _ _ __ __ __ _ _ __ __ _ _._ _. _ __ __ __ __ __ _ __ __ _ _ __ __ _ __ __ _ __ ___ __ __ __ ____ __ __ __ __ _ -_ ___ __ _- __ AUG-22-2026 11:43 FROM: JEO CON6LL17FIG GROUP 71.5-246-3630 TC:248793 P.001/001 PRELIMINARY PLAT OF - RICHMOND ACRESRa2e-4 to COWN PIA LQ vw m pro ( pm SW4wff1 r JY mu foop S-mw f V4 of 106ft, 4 rb," Awfq, Af of low. rvpn of Wpi,: ro t-b cbe(.4 r�IW ik Ile 1 . 11 1 , qp NI ec Wool tm 521' r 14. r,Ilc was kN0ir4j WIA i4 3,W6 �, r , r ' 'r >�o� I �. / ! r� ; •r� ?�,"'. •s .. a ��; ; 1,..: ` 1 d4l1 �',.�` � �� y � Z, 4e L N toy m •Qr• �'�r?�,,,. ` r ! I 1 �,� . � ..... _ ,H ! J ,. 1 � I In N 4 �OC 2,25� & o fo t. M&A 2 6� no J � , ILA o pi pl g 24-1 cc r L Cres or A. 0 arts � Z �• J, ' roe , - P. .� J �`'9 {' �� ,..,i, 1. 2aarr) �, r � 2,4 l A Ora" a 2. 79 t"', 1. 793 was 7 .9 1. 4 vVeS .11 1 o.K AP 118 mfts 07 Wool IN L, A gow S. gF.- - ` - •r _. r ... LpT� � - `1 ;l va oom 8 POP" Y'dAP w ell chon 21 aCr �n1 yf� m WS oow �,�/ �_ I CMCX11iIN MsKI T / T T." 1 / `., / IJ . .�. n� v G�— Nffll .0 —on .1 W000— It 04111 C. L ot. CC 75 acrc r.� l WI oom j opm R ' A. 11 OW mo a/ Va. - ow / // mum I/. a*%F C9' 07 p; ge CPAA%J1110 SMV 6,1— lane L Idw rmov% 04 —IMMEM ic T.. Parcel #: 026- 1082 -70 -100 11/02/2005 02:28 PM PAGE 1 OF 1 Alt. Parcel #: 28.30.18.435 026 - TOWN OF RICHMOND Current X! ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - RICHMOND ACRES LLC RICHMOND ACRES LLC 11160 190TH AVE NW ELK RIVER MN 55330 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 16.600 Plat: N/A -NOT AVAILABLE SEC 28 T30N R18W SE SW EXC PT TO CSM Block/Condo Bldg: 8/2199 & EXC W 1/2 E 1/2 OF SW 1/4 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 28- 30N -18W Notes: Parcel History: Date Doc # Vol /Page Type 09/13/2005 806245 2887/022 EZ -U 07/26/2005 801423 2851/077 QC 06/03/2005 796642 2814/533 AGREE 06/03/2005 796641 2814/531 �I1ID m re... 2005 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations Last Changed: 06/20/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 16.300 2,700 0 2,700 NO UNDEVELOPED G5 0.300 100 0 100 NO Totals for 2005: General Property 16.600 2,800 0 2,800 Woodland 0.000 0 0 Totals for 2004: General Property 16.600 2,900 0 2,900 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges p p g 0 00 Total 0.00 0.00 71110H 60 • �gmoj I I �� o x C gti n m o x o x ni c m ° c o f ��I` W`� ---p R)t. 1 �' p m �/ m avlp _ m ". •�O\ \.� :l `•�... -- -'_"y 1 a Q Bb 860SLOLM o� °o °3z I BC •. \,��` \ 1 o ° n° Jr0 - ra A m ° ? n O m I �'i x i `K L 11 m pp o � 1 �1� O � CH? � .Al ,tt ,t\ `\� �.` ..)....).... �"' "' �v n yjy Ta �y�n a ° a Itil� Gl e C) \x a_ x�i off' >N » Inn '�Z __ _• ^., �`..`...� 1 .: ?� <�� ! -• ;LLB' z� lD'�oYiiy7 =1�i1 N Z F x %U ,. p O m n > 8: <z + � m C°L+ m ur Z 1 n g �5 � C) `. 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