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HomeMy WebLinkAbout026-1294-19-000 r Wiscgnsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. C r o ix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 488014 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: Smith, Gerald Richmond, Town of CS T BM Elev: Insp. BM Elev: BM Description: Sectio own /Range /Map No: (JJ— J 'D P 28.30.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � _ � Benchmark Dosing ( � Alt. BM, vK � I • C ���, �2a � 1. �' � 2 Aeration /il, / `,) Bldg. Sewer S, Holding SUHt Inlet St/Ht Outlet TANK SETBACK INFORMATION d / 3 TANK TO P/L WELL BLDG. Vent to Ai a ROAD Dt Inlet Septic f Dt Bottom -� - Dosing N Hea er /Man. Aeration Dist. Pipe Z C / o • - Holding Bot, S st I / - Final Grade 3 -- PUMP /SIP FORMATION Q� 4� lOd (!P- v 5 - Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss Head TDH Ft V (t/l Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM Z f ''j = BED/rRENCH Width Length � o. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS D l SETBACK SYSTEM TO P/ LD WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER Model Type System: �' 0 �� l - rl t7D tv f�Z__ DISTRIBUTION SYSTEM Header /Manifol I Distribution q ( x Hole Size x Hole Spacing Ven Aur Intake I Pipes) 1 ✓ I / J"'✓ 1 1-ength - u ' � -U pia Length Dia Spacin 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 L, Bed/Trench Edges Topsoil 9 p Q Yes 0 No If1 Yes Rfl No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection �/ Inspection #2: / / Location: 1156 134th Ave. New Richmond, WI 54017 (NW 1/4 SE 1/4 28 T30N R18W) Richmond Acres Lot 19 Parcel No: 28.30.18. 1.) Alt BM Description = WA �e � -7L�0 k -tD W (uld �� �� � �k� -� 2.) Bldg sewer length = I �' (1Tl _ crl A 33 - amount of cover Plan revision Required? Yes W No / Use other side for additional information. L ' � I � O _J -�2C�� �� - - - -- - L — - -- SBD -6710 (R.3/97) Date Insepcto s (ignature Cert. No. l I ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OwNMSHIP COLTIFICATION FORM o wwmuye Mailing Address A\6 r� I +i A M �'.1rU` �LIC 0 M AI Property Address (verification req=%d from Plamdmg dt Zoning DepwW of for new conshuc ti0 .) CitylState Parcel Identification Number LEGAI. DESgRWnQN Proparty I,t,r.ation A `/a ,' /< , Sec. , T N It 1 8 W. Town of t G!i �+ Subdivision F' 1(► 0 � � 5 , Lot* . Certzed Survey M&P # 3 Volume _ , Page # warrtanty need # Volume , Page # spoc hours yes no Lot amen identifiable yes no SYSTEM MAiNTENANCIr AND O'iiVNI�Tt CIv1ZTYF�CATI�N im MPW use And ,poqunce=e of y M septic system OMM result m its premaare fli M to htaaclie wastes. Proper mai�a omailts of pmnpv*, out &e septic task every three y em or mom, if needed, by a licensed pumper. What you put into the system can affect the function of � septic taAlc as a Zeeatment stage in the wASCa disposal system. Owner msndteasnee t�esporttJ"tws at spvci5ed in $Corom• 83.52(]) sad m Chapter 12 - St. C�ni%CouAty Ssnifaxy Ordinance. TM property owner agrees to submit to St: CIM Cownly Plaa=D& & Zoaiog Depactnumt a $+ d by the ar own and by a umster plumb0c, jonamcyn= plunoba, rartdded plumber or a licensed In in gmc verifying ( ) � � wa disposal "dun is in propez %waft cw&ti*n and/or (2) zber inqmtkM and w ing (if neoessaty tiro septic ttmk is less than 113 W of sludge. Vwe, the undersigned have read dw above xegnfremeats and agree to mismum the psivatC sewage disposal system with the standards set forth, hem, as Baby ttte Dapartmant of Commm+ . and the D"wunestt of Nau=3 Rcwmrces, Stott of Wisconsin. Cerele im stating that yoae septic systems bas been maiatsiW must be completed and roonned to fora St. Crocr County planming & Zoning Depa ==t wif a 34 days of dw three yeas VTi nd= date. Vwe can y that all atateanene on this fawn are true to the best of my/our imowle ftc- Vwe axalare the ownw (s) of the Vaperty des=W above; by vnUt of a wnranly dead recorded in Register of Deeds Offim Nunkber of ms SY x A F APP'LICAM(S) DATE *-*ma ;afomaticm that is m may rmdt in the sanitary permit WIg revoked by the Plate & Zoning Deparmmnt. *" Mcbj& with this application a recorded wananty deed fro dw Register ofDeeds Office and a copy of time eerMfied surny mW if rs&ren+oo is made is ft wwnzay deed. (REV. t Z - d XOA AA3f eeg:60 90 8Z noN ' Sji=106 201 W A � 53 p VE� Pexmit N=W (to be MW is by Co.) b6 -3151 (J Department of Commerce 0 Sanitary Permit Application 2 �; Plan l D. N bw In accord with Camn 83ZI, Wii. Alm. Ca&, personal nary beueeditawafty papa= ftvaWLay,% �TrN rXCOUN1`Y 1a*/W�as(d �f flmnmarlmgaddras) G OF Ejr j z L A,ppltiadfto Ina wmatbm - Plam Print AQ Information r PmPoril, �+m's Name 3 Pocd # J Block # Property OWWs Mailing Aftwo 1 1 TR A V' SE section Z CaN saft zip Coat Phase Number - EL 1'1 VET.. W 1 - 7 65-'gli , 868 T 3n i � , IL Type of Banding (ebak all that apply) Z Fe- Subaivisim Nme OM Nasnbor ".t,or2 Family Dwdlmg- N=berefBcdmoms OAMidC�mmereW- DesaibeUm ❑ SUft Owwd- Desm%c Use Doh! pvUbw ir' • of UL Type of Permit; (Cbeek ealy me box on run A. Compile line B if applicable) A ZNew Sysaao ❑ RWwo mat sysi m 011eaamm lolling Tank Replaoammt 0* 0 oilier Moth MfM to Bxislin syswM B. 0 Permit Renewal 0 %, Rtvision 0 Clwnw of 0 Peanit 7b A fo New I ist Pn:vioas Pbnnit Num6a dad Date Lasted Burt Bxp im Mumbw owner IV. TRW efPow" CbwkaBtbat kim - Ptesatuimd 1n -Gra®d 0 Mumd>_ io c£suble soil ❑ Mc�a�d <24 m �suimbk soil ❑ AVQrsdo siog� Pass sand Fi7ber ❑ ComtU Yfta wetland 0 Pre wmd 0 Tank 0 PMFMw ❑ Aerobic TnMnw ttt b'nd 0 Rpe a sand Filter ❑ Syndwic Mv& FtMw 0 Drip Lmc ❑ Gaavd-kas ( V. Dispersalfr Area Inbronathm: Desip low6t]) DeeWSot'l 'j; Zdio' RateGBt t) �I 1(so sfl SY ✓ 473 6 ,/ 25 S�F 50 3? �� 163 az.s ion VL Task Info Cgmcity in Taal Number Mn+a uer P b I Sim Sled Fibw Plastic CbMIGM Cdlatts ofL%ft Conm to Cambucted tills NOW axbft Tads Tools Sg6c- HaWwgTadc 0 i / k AaiAk TioMmart flint DapasCrtaaber VII. Sb -16 tie mwk s%poA ama®e far me POWlS shows as tie athwbed plans. Piambtxs Name (Print) B Phone Nrtnber Phanbe PAMmas Cllftek Cky, sale, Tap CM*r P b. 3 fix ` r DP.- `SS -'1 W VIM . ❑ saa>tat), %. Fm Ci� were 77 00wnwC =Rtassnfor•DamW Fee) ti 0 D MV4 / " IR- Coa�ea of ApprevallBearaes for Disapproval /,� r29. STE and ( /,, _ (� Septic tank, effluent filter dispersal m cell must all la serviced / maintained n A /� 6( a � as er m meet Ian provided b All setback requirements must be maintained I 0 as per applicable codelordinances. alv�a, Athtieamptdephaa (to dwCattW for 8tt:a } stasmpapa not Ina Sam SMx11 to dm SBD -6398 QL 01/03) i GERM - NuL S N\ CTf( 1 11 �6 1 '7 , 74( AVE Ad lm'4 SE (14 s LA `r ,36 0 IA 'ELK R ERZ , N1 N kteA mnmo Tws 55 -33 L0 i I �i �1 d� U NI PO g.M 2 `mP ©T STE.zL f 1 PE :r-I,Q 6 M I TDe O (1 If Zz 32g Z- q , 3 STL P)a" ICte ✓ , Ioo u5 /oob l h C-AR &E 0 SOIL 13 (Z1 IJGS smLE I 9D' III 431 TH Avp vwft GEi2f�l� s M cT +( l t l bb 1907 ATE IQ. d Nw'4 :SE )4 S Z� rya ale, IRWE IZ. , R W AMOMC 7UIS P Ss� [5 L C 1 A O R,t M18 plc S V &M, I TDP of N�PR� Zz3X92 sTE15L �►r'� �tL ✓��oo' 1 w6 �/ 3 �U1�ODnt \ J� A , lo 0 0 SOIL 20 R-1 Wt .S scf\Lc- i Avp H � o � b c W �. co O ! a rA O CD •CI � • • .-. CD OQ CD CD = d m - • .y � � � Cbd co D �� Q 5 CD co I~ u I � rPA) � 11/28/2005 09:59 7634418727 PAGE 01 ST. CKM COUNTY TAW Aar AM OWNEitSW CEM MCA IZON FORM w �1�9 Aug It e' MN 553 _ pop" AddMm (V tegrol�ed 1�t� DepsebearR aew cosrdneaoa.) OA WA vida sumac . M OM— c ga J L19 Vahm" . s Loam y aoa,m�masre oRtrosr xp sly mwdLw irptaoftebs bt�edldE rw ao os co 4a+ra e[P ° �°° 1� a'O0O0L, ifneeded. M►s P • ' reap�icras eras M Wee i S3.s3(l) nd Is 1� CfOhCmNK SmiM 00 dlh' m+• mrieee�oe 'fee IMP MOW * mate* rs fit Crok Gloow pldnM A T.edw Depamrest s erttifiastira fsm efySsr "*8 dwaae rmlbyr►ae�arpWsbet.iiD 3°°°"dpas�ecs �ett)is otter �' rse�°` t'° n' m�pae� est�''•oe.'.e�1.de:eptic*mkm lees dire 1/3 fiat of shWi . vns,+Ibaatdetsi red dce sbanemgo�� ee mrAm4ind►syr;rmrt eew� � w i ee �M.sre �>�.�. rraub!►dre � b� �de�Ca�aY tLsebos � e d 71 O sy �,eei�Daprranaot wifb�► 3Q� �d�dmee yas drer• the cad* *M aD rtstmrscs OR ri fMM ace tree b 20 bets d'mpftW Imswlsd/e. I/ws arAAere dr. swmR�! di plop" done" abme t yV *Mwofs+rMdiaal►dsedseoo`d�d�l COerrfDe�d�O�ae. Nmmbws SMATM OF APFLWAMM) DATE ouim dw is nw temp is tm s=Atwy Pegg* beiad eesdod by 6s pftwoI g b zooft Do"Now t. o" tetrads wJ& Ws s r mnbd w ea m y deed *mdo Rqpw of D,ede Of kv and s aoplr office oard0d Frey tip W mlteeos 3s am& ln*A wraa * am& Z'd XDA Aj smaD @L MN POWTS OWNWS -MANUAL &- MANAGEMENT: PLAN _ paw of FJE•Uffi=QRWlATIOAi Ku. , ' ,� s Tank capacity - 0 ' E3 Permit # J�O ! Tank K1'C' - ❑ NA •o DEMBN PARAMETERS Etfluem Fitter Ma"Otac�am 7 t1 6� ❑ NA i of Bedroons O NA Effluent Filter Mode! - jOQ [:? NA Nt r of Public FacWW Units V NA • Pump Tank Capacity ONA few (average)- ; ^Oogallday Pump Tank Manufacturer V NA flaw (peak). (Estknated x 1.5) '�v g al/day Pump Manufactus er H NA Sod •Appfiation Elate ` 9� � Pump Model r st ndaux(, Quarity Merahly average; P r at Unit NA Fats. Oil & Grease (MG) S30 mg/(. 0 Sand/Gravel Filter O Peat Filter Mochernipal Oxygen Demand (WDj 5120 mg/L ❑ NA 0 Meahw a3t.Aeration 0 Weiland _ Total Suspended solids (Tss) 515o ri,4& p won- p pthw; Pretreated Effluent Qu"W. - y Idl&dhly average D'espersal Cell(s) O NA Oxygen Demand WOW .5i0 mg/L )n -Gmund (gravrty) O• kWkound ( ) Total Suspended Solids O'SS) ,530 rng/L NA U At-Grade. ❑ Mound l.Cogfmmt (gommetruc ine�aun) -Si W cfu/1Omni •p•DrilHine O :Oth ; Mai*xwm � Effluent Particle Sae Y. in do- 9INA �`' ❑ NA Other: NA Other. NA * Vakses typical for donwwti: wasp v am and septic tae k effluarrt. Other ❑ NA WlAgwmLONCE SCHEDULE• .Service Evomst Service FrequMcv - Inspect condition.of tank(s) At least-once every: ❑ m(Ictth(s) (gym 3 years) O.NA years) Pump out contents of.tank(s) When combined sludge and scum equals one -third 09 of tank volume O NA .Inspect call(s) At - least once every: D month(s) (Maxemwn 3 yians) 0 NA '. Clean effluent filter At least once every: ❑ month(s) O NA Irmnect Y�(s) � Pal}. Pump controls &alarm At k3ast once every: 0 Ye7f (s) 0 Q�q f Flush laterals pressure test At least once every: 0 iT 'dt(s) . O year(s) I Other. _ least once every ❑ morrth(s) NA D years) Oche, ' I' Inspections of tanks and dispersal cells shah be• made by an nufwWual carrying one of the fgNqwmg licenses or cerdficatkxw: Master'Plumber, Master Plumber*PAsuicted Sewer, POWTS Inspector, POWTS Warmer Septage Servicing Operator. Tank inspections must kx*sde a visual *L-4 action of - the tank(s) to identity 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 pounding of effluent on the ground surface. The dispersal cea(s) shad) be visually kugx ud to check the effluent levels io -the observatory "pipes and to check for any pondrng of effluent an the ground "surface. The ponding of effluent on the ground surface may nxr= s a faring condition and requires the atwr tliaae ttodficadon of the local ree(pilatory authority• When the co Wow d accurnuLitiori of sludge and -scum in • any tank_ equals quals one -third (3C) or more of the tank vofurne, the enth contents of the tank shall be removed by a Seprage Servicirg Operator and armed of- in accordance With chapter - NR 113. Wmc,onssr Administrative Cow. A® other services, inciuding but -not kni'ted to the servicing -of effluent facers, mechanical or pressurized components, pretreatment twits. and any servir3rrg at intervals :912 be performed by a cerdfmd POWTS Maihtairw. ' A service-report shall. be provided -w the .local regulatory authority within 10 days of .completion of any service event. 1 L o AND OPERATION Page � of _� construction, prior to use af.the. POVttT'S tt eatirtant tankis! for the Inayoirnpe.". the the e 9 �ator.P,*x to us, cepisl. If am dd6tec� ate, tCfi nt m t s its start UP shall not 'occur when.soii conditions we frozen at the infiltrative surface. Dtiring Power --pump tanks may fill above normal highwarcer levels When d� to the d ,Cans) . in one � .dose, overloading the ceUi and Power is restored the excess effluent.. To avo� :this may result. in the backup 7 Will power to the effluent pump a .� a ��er of the pump tank removed by a Sepmg g Opp die . of restate ncm rsa! within the pump tank. T'S or POVYT'S Maintainer to assist in manually. operates g the Prior to ntols r to ols Pump contr to Do -not drive or Park vehicles over and dispersal with any mound in )S feet.down slope of Cep not drive or park over, or otherwise disturb or or at soH absorption area fact. the area Reduction or elimination of"-the following from the wastewater stream POWTSz Wform and Prolong th improve the a e life- of the fr�dation d �' was: cigarette burrs: con doms cotton swabs: degreasers; dual floss; P1 water; fruit and vegetable . drapers; d�+nfectants; fat; 'Painting Products; Pesticides; sanitary napkins; tampons; a dd F �� brim ��� meat �K'atiocts; oft: ABANDONMENT When the POWTS fails• and/or is Property and sat abandoned �' taken out of service the following steps shad be taken to insure that the system is �' oned in compliance with chapter Comm 93,33, Wisconsin Administrative Code: • All Piping to taroks and pits shad be disconnected and the abandoned PrPe openings sealed. • The contents of all tanks and Pits shall be removed. and Property disposed of by a Septage servicing Operator. • After , pu another inert all and sot, gravel. pits shall be excavated and removed or their lovers solid rnateriaL removed and the void space filled with l CONTINGENCY PLAN if. the - rn PO WTS fails and cannot be repaired the folio wing measures have been, or. must be taken, W provide a code compliant i'�ent" A suitable rnPtacernerrt area has been evetuated and may be utfi¢ed for the system_ T he-replac -meet area should be protected from d' location of a replacement sod absorption required setbacks from b an and compaction and ShQLdd not. be irdrjVW. upon b result in the need for a n and Proposed structure, and wells. Failure to protect the replac ement area will site evaluation to establish a sortable replacement aroma. mast Replacement slesrs cwnpiy with the rules in effect at that tune. - _ A . suitable replacement area is not available - due to setback and/or soil limitations. Barring advances in POINTS technology a holding tank may be. installed as a last resort to replace the faded POWTS_ *site not been. ed to .- a suitable be r�eplacernent area U � g tank a Pon failure of the POWTS a sot? and site tMrhr to la ble rept tf no is available a holdin as - Place the yyT$_ ?ound and at infiltrative sutfiace. a so" on systems may be rimed in Pie - following removal of the bKunat at the of such systems must comply with the rules in effect at that time. < <WAi> > - SlgsER PUMP AND MP OR TREATMEN TANKS MAY CONTAIN LETHAL GASSES• AND/OR MSUH4CEWT OXYGEit. DO NOT ENT A SEPTIC, PU OR OTHER TREA77Y ENT TANK UNDER CIRCUNlS3,4NCES. DEATH MAY RESULT, RESCUE OF A PER SON FROM THE INTERIOR, OF A TANK MAY "BE DtF RCULT OR IMPOSSIBLE, ADDMONAL COMMENTS -POW S 09STA r R POVVTS MAtNTA94M Name � Name Pho S — 3/ 'Phone SEPTAGE SEFMCI NG 0 P93A — OR (PUMPER! Name LOCAL REGULATORY AUTHORITY Ptione zoo �1 b— Pfione 715• �38� y bib was dmftw ; with chapter Comm 8 3- 22fZ(b)(1)(d) &tf} and.& i Wisconsin Department of Commerce ; \` L EVALUATION REPORT Page of Division of Safety and Buildings rn ce with Comm 85, Wis. Adm. Code County C Attach complete site plan on paper not Ibis than 8 1/2 x 11 `'' U include, but not limited to: vertical and horizontal reference I: :)int (B D Parcel I.D. - percent slope, scale or dimensions, north arrow, and locatio i and distance to nearest road. Please print all informatio . ry Reviewe by Date AU G ;3 " 2005 , Personal information you provide may be used for secondary purpo s (Privacy Law, s. 15.04 (1) (m)). r Property Owner P rtY ST. C C�1'72f�X1�PFittion ZON W F CE /4 SE 1/4 S a$ T3u N R E (or Property Owner's Mailing Addre Lot # Block # Subd. Name or CSM# / 90y e. N W at o f R is h m c rc City State Zip Code Phone Number ❑ City ❑Village ® Town Nearest Road 't � F1K R'.�C.R KIN 3 ( > - 8 Ric m t,. (S New Construction Use: T� Residential / Number of bedrooms Code derived design flow rate _ S GPD ❑ Replacement — O& AA El Public or commercial - Describe: _ Parent material _ t'. & A A sa es V-% I T• I I V%A i �& Flood Plain e!evation if applicable ft. General comments = 5 U5 5 S, t 3 — T r Gr% Cj^ S � �{ � F o r e a. Lt^ 5 r'1' G . and recommendations: 11 . ( �i o3. D.1 —�-� Y S�e 1 -t'.2 C ioa. . ( lao -�g'� t•3 001. 1 31) T. 6 Boring # ❑ Boring o 54 Pit Ground surface elev. _L0L 3!: ft. Depth to limiting factor 7 75 —in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0 -11 I YR 3 / - L A F S br, mf r aw a 6 g 5 y9 7 5Y2 �1 _- 5L 6 , t , t, ) . ! !_/- ® Boring # Boring J •�S ft. Depth to limiting factor s in. iA Pit Ground surface elev. Soil Application 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 I 'Eff#2 1 0 0`fR 3/A L '7 'SYR W /L _�,. e m }r r` C � I P H 1-G5 ,t: r Cto 1 v F Ljo I. 03,0 kh 47.0' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 1150 mg/L ' Effluent #2 = < 30 mg/L and TSS _< 30 mg/L T Name (Please P Signature CST Number a.rk A d Date Evaluation Conducted Telephone Number L ���' - 7 -aa -d - 715 a�a sss Property Owner Gera'b V �Jn'1 Ak Parcel ID # _, Page CQ _ of A- Boring # U Boring rr � 1 1 31 P ' pit Ground surface elev.1 t ft. Depth to limiting factor / f�0 _ 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 I -1Q I O yR 3 /a — L F P L , q 110 v� 04;k It)Y(Z 51q �!`' V ( I w% ( L v - n 3 a s , 5YR �/( _ _. IB C v°f tY1 ' C w � v 1�✓ � �'�,.,� �, :(fie r• D 2 .6 Z " � 1 Boring # ❑ Boring ,� pit Ground surface elev. J �9D 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 -13 l D 31 -- L. a f551_ MFY- OV-) :) � . V :*Sb >t vvN Fr I i F I t o , Boring # El Boring _ F ❑ 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 Or. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 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 (RAW) i Pal QN y y, e YO i .g 0+ 4 f b 7 a t NMI 4 z g17 40� � Z o0 n st -1 Ito, II, ►4� S�ot,k co d .o 8o o o`er. CA C.� b Q -- ----- - -- - - --------- Hll(a - 2c -20 11 :4:3 FROM:JEO CONSULTING GROUP 715- 246 -3830 T0:2487B39 P.001/001 • PRELIMINARY PLAT OF RICHMOND ACRD'S a e• H y cA =LIPM rL.r ,am+sv N wrr Af to S*Mwwf UV ad MY S1 MMII 0/4 M 5KdAw *4 1iA jAp M Ma", AA S* IY *04 r An of frrm•XAwwf d1 PAI+ 6sn4f x60AAAAA •�. "` w 9 � ^ N t�Nf�iAr9b 4 • •` �._... -. � Arr uA..i w r �� _ eitf� 2 A .Ana 1 ,.Idt,Ar ^ ^.i� , I r .! I 1.8 A wn '� `T f � / �� f � � �� � / •701: •f � s ��"� 2.�J '\µ r y d. �,. i'� N. A - • ,» + L+, / 7 a� r 1 "°sS... O' ,r.�'S�aC 1 z 43 eat A{ grik\ ., T' : 17... r A . - ._.�M ,• =►` r �' re \. • / . I r ` ` �, { fir( � �,C r- r • r., 4.�� � �^l.:� \ 13 \ u. 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WALSH QUIT CLAIM DEED REGISTER OF DEEDS ST. CROIX CO., WI Document Number Document Name RECEIVED FOR RECORD 07/26/2005 10:00AM QUIT CLAIM DEED THIS DEED, made between Gerald J. Smith and Jeannine B. Smith, husband and EXERT # 10 wife REC FEE: 13.00 ( "Grantor," whether one or more), TRANS FEE: and Richmond Acres, LLC, a Wisconsin limited liability company COPY FEE: ( "Grantee," whether one or more). CC FEE: 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 - 108240 -000 Parcel Identification Number (PM) This is not homestead property. Dated =� /0 07O i (SEAL) (SEAL) erald J. S nawnt B. Smith (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on STATE OF w1ss'- I0 1S1 /1 ) c l ) ss. 3T ivlX COUNTY ) s TITLE: MEMBER STATE BAR O ONS Personally came before me on (If not, e above -named Gerald J. Smith and Jeannine B. Smith, authorized by Wis. Stat. § usband and wife o me known to be the person(s) who executed the foregoing THIS INSTRUMENT DRAFTED B instrument and acknowledged the same. � STATE dF Kristina OLrland, Estreen & land ' �- 304 Locust Street, Hudson, WI 54016 Notary Public, State of My Commission (is permanent) (expires: 9 ra S'bs ) (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 ® 2003 STATE BAR OF WISCONSIN FORM NO. 3-2003 • Type name below signatures. INFO -PROTm Legal Forms 800 -655 -2021 www.iMoproforms.corn U 2851 P 078 EXHIBIT A Parcel I The East Ralf of the East Half ofthe Southwest Quarter (EI/2/EI/2/SW1 /4) of Section Twenty Eight (28), Township Thirty (30) North, Range Eighteen (IS) West, Town ofRichmond, St. Croix County, Wisconsin. EXCEPT 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 (SW 1 /4 /SE 1/4) and part of the Southeast Quarter of the Southwest Quarter (SEl /4/SW l /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/2/SEI /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 (SE1 /4/SWl /4), both in Section Twenty Eight (28), Township Thirty (30) North, Range Eighteen (18) West; 2. Lot One (1) of Certified SurveyMap 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. Comm inert ing at the Southwest corner 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 0 59'15" West 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 p oint of be 8i�g; 4. Commencing at the Northeast corner of the Northwest Quarter of the Southeast Quarter (NW1 141SE114) 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 beginninng. o� [fi � I .+'t ► I UL x 16 s g r I I I I o