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HomeMy WebLinkAbout026-1294-16-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 552376 0 GENERAL INFORMATION 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 Richmond, Town of 026-1294-16-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: C :5-r 28.30.18.1498 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic j \ J T... t Benchmark Jos 3 5.3 / ,6,` Alt. B 1 1154K7.4 Az . CLr 44- _e' 8e Aeration Bldg. Sewer Holding St/Ht Inlet 7• 2,5 IV-65 TANK SETBACK INFORMATION St/Ht Outlet -7, 55 75 I TANK TO i 'P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ~ w /mod J L, Dt Bottom Ier 7`D ✓O Dosing Header/Man. l •1 R7• I/ Aeration Dist. Pipe 9f $.1 L Holding Bot. System , b (p . 3 9 • ~ 9l0. Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM fr; Id-7 , 9 Model ber TDH 'ft Friction Loss S ad DH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 Z ~ \ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: -r' n INFORMATION CHAMBER OR / Type Of System: n ~ Gonystem: 0n 71; /56 ' UNIT Model Number- A4 54 ,f a ,~J DISTRIBUTION SYSTEM gF = S to us Header/Manifold Distribution 0 A)C I x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) a t1r.. / Length Ir Dia Length Dia \ Spacing 7 1.50 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Over x Dept f xx Seeded/Sodded xx Mulch d Depth Over T FDetTrench Bed/Trench Center 7 Edges Topsoil Yes No Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1348 116th Str6.'14c- et New Richmond, WI 54017 (NW 1/4 SE 1/4 28 T30N R1 8W) Richmond Acres Lot 16 Parcel No: 28.30.18.1498 1.) Alt BM Description = L o Gk o- 2.) Bldg sewer length= - amount of cover = > y o ~0 Plan revision Required? ❑ Yes No Use other side for additional information. Z SBD-6710 (R.3/97) Date Insepctor's gnatu Cert. No. Safety and Buildings Division ' 201 W. Washington Ave., P.O. Box 7162 County Cpryt1Y1@rC@.WLgOV 'cons' Madison, W1 53707-7162 Sanitary Permit Number (to be filled in by Co.) L__ Department of Com ' 3 :7.,62 State Transaction Number Sa it Applicatio In accordance with s. Comm. 83), s. Adm. Code, submission of this fo the app ovemmental Address if different than mailing address) for state -o WTS are project unit is required prior to obtaining a sanitary permit. Note: Application f s of Commerce. Personal information you ov]de may be used~f ondary S~ su rposes to the Department / purposes (l / /G in accordance with the Privacy Law, s. 15.04 1 (m ,Stets. J Q / 1. Application Information - Please Print All Information -Parcel # Property Owner's e G D r/l erty Location Property Owner's Mailing Tess Propoa J Govt. Lot 2 O City, State Zip ode Phone Humber t A/ ~ -A Section / e ) , • cle o / C.c...J l~ W I T N; R E if. Type of Building (check all that apply) Lot # ✓ Subdivision Name or 2 Family Dwell' g - Number of Bedrooms 1 X ~ vytc Block # Public/Commercial Desc,ri a ❑ City of CSM Number ❑ illage of ❑ State Owned - Describe Use wn of - 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. 54ew System ❑ Replacement System ❑ Treatmentiflolding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS S stem/Componc._t/Device• (Check all that apply) on-Pressurized In-Ground L1 Pressurized In-Ground 10 t-Grade ❑ u d > 24 in. of suitable soil El Mound < 24 in of s itable soil c _ -f ! ❑ Holding Tank ❑ Other Dispersal Component (explain _ d"`t' ffletreatment Device (explain) vvt V. Dispersal/Treatment Area Information: Des] Flow (gpd) Design Soil Application Rate(gpdso Dispersal Area Required (sf) Dispersal Area Proposed (sf) S stem E ati t 0 41-1 0 //70-- V I. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanks U w C7 P. 1*0 a) Septic or Holding Tank) Dosing Chamber VII. Responsibility Statement- I, the undersigned, assu esponsibility €or installation of the POWTS shown on the attached plans. -mb Plu ',S Name (Print) Plumber' store MPIMPRS Number Business Phone Number /[l ° f. Z Om', I -ot O _ %V 9 Plumber's Address (Street, City, State, Zip Code) VIII. oun IDepartment Use Only Permit Fee Date Issued uing Agent ' atur 4 Approved ❑ Disapproved $ d-0 G2~ ❑ Owner Given Reason for Denial 7 5-~Ia IX. Co ddltions of Approval/Reas s f D' approval G (p f2 iQel 0--.211 ~YSTEM OWNER: ~ GW[ ' 1 Septic tank, effluent filter and 14 dispersal cell must all be serviced / maintai 'ned s GJ ~ 4WX_--) as per management plan provided by plumber. 2. All setback re - as per applical?t69~'~rices r d auhmit to the County duly on paper not less than 81n x 1.t inches in size Imp SBD-6398 (R. 02/09) Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 6/4/12 Owner: Oevering Homes Location: NW1 /4 SE1 /4 S28 T30 N,R18W Lot 16 Richmond Acres 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 Continge cy Plan 7. Filter Specifications Shee Signature License number # 6 0 PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NW 1/4 SE 1/45 28 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/6/12 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK 1000 gallons LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1 141 # of chambers 56 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100° Filter BEST Filter H.R.P. Same as Benchmark ~ySfP.ti- t l?✓ v,.~ z Y ❑ BOREHOLE O WELL ~ / SW B M.* Property Line j CO (4 Well is to meet all Vent setbacks required by >6„ Quick4 Standard WDNR Leaching Chamber of Cover with 20.0 ft2 of Area g 10.2ft^2/pair of end caps 4' Long 12" Grade at System Elevation 7% Slope 34" 15'B-1 40' 70' ' All pi in shall be SDR 30/ J-1, W . thin Vents 10'B-2 o an , piping shall be Schedule 400 AS M 100.5' 20' 100' B-3 S 101.5' 2-3' X 114' Cells with >3' Spacing 80' Pro 3 Bedroom House Property Line 116th St. 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 To be >1' above grade 10.2ft^2 pair of end plates Finish grade elevation Typical Installation 101.0' Vent X/ Grade Vent 3' 4„ 3' x/30/34 Septic Tank 5' 5 Long 5 Long Grade at System Elevation 3697 Grade at System Elevation -9G s' Spacing 5' 2-3' X 114' Cells Same on other end Observation tubeNent At end of cell A B 28 chambers per cell _ System elevations: A__96.5 B__96.9 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page l of FILE INFORMATION (L 6dLnr 6 r r SYSTEM SPECIFICATIONS Owner LL~ Septic Tank Capacity gal ❑ NA Permit # awl _4=2 Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units NA Pump Tank Capacity gal NA Estimated flow (average) gal/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) J gal/day Pump Manufacturer NA Soil Application Rate i gal/day/ft2 Pump Model NA Standard Influent/Effluent Quality Monthly average*! Pretreatment Unit NA Fats, Oil & Grease (FOG) <_30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) :5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :_150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODS) <30 mg/L In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) <30 mg/L NNA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) :_104 fu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ ~lA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: J ❑ month(s) (Maximum 3 years) ❑ NA year(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once ever ❑ month(s) (Maximum 3 ears) ❑ NA y' 3 year(s) y Clean effluent filter At least once every: yonth(s) ❑ NA ear(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s), Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ month(s) At least once every: ❑ NA ❑ 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 on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check 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 (%3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical 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 completion of any service event. GMW (4/01) I Page Zof START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage 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 above 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 Operator 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: e 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 reKenstem. t system: suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption The e 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 Name Name ~C Phone 7"--60,T J~ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name ` Name rte, u,, a? " a 6-S y~ Phone 1-7j Phone 71,j This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK. MA'NTTNANCE AGREEMENT OWNERSHIP LCERT A DZCATIONFORM Owner/Buyer ` Mailing Address _Z'7 35- Property Address ?j /l aI ~ AZT - ~ /~lro ~ sT (Vecation required from P1 arming & Zoning Department for new construction.) City/State ll~Q{,cJ Parcel Identification Number .LEGAL DESCRIPTION y1p Property Location 1/a%, , Sec. 2 30 R/~ -W, Town of _ Subdivision , 7` ~ Certified Survey Map Lot Volume Page # Warranty Deed # Volume Page # Spec house ye no Lot lines identifiabl yeS o SYSTEM MAINTENANCE AND OWNER CERTII''ICATION Improper use and maintenance of your s rs o maintenance consists ofpu aping out the oseptic tank every three years ooner~ the system can a fneed d, by a lice idle wastes. Proper ffect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Cornm. 83,52(1) and in chapter 12 - St. Croix County Sanitary Ordinan ewer what you put into The property owner agrees to submit to St. Croix County and by a master plumber, journeyman h' planning & Zoning Department a certification fo wastewater disposal system is in Plumber, restricted plumber or a licensed signed by the less than 1/3 full of sludge. Proper operating condition and/or (2) after inspection Pumper verifying that (1) tile on-site Pimping (if necessary), the septic tank is V*uve, the undersigned have read the he herein, as set by the De standards set forth, above requirements and agree maintain the private sewage disposal system with the Certification statin p y P~nent of Commerce and the Da e g that Your se tics stem has been maintained must be co pent of Natural Resources, State of Wisconsin, Zoning Department within 30 days Of the three year expiration date. completed and returned to the St. Croix County Planning & Uwe certify that all statements on this form are true to the best of my/our knowledge. 1/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number o rooms 3 7 SIGNATURE OF AP LICANT(S) `6-/ 1,~// Z DATE Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & zoning ,x* Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified reference is made in the warranty deed. ed s urvey map if (REV. 08105) Air. Wisconsin Department of Commerce L LU TION R~ Page / of Division of Safety and Buildings accorda WiA(, mjj(m~~85, Wis. m. Code ;ffes~'i~' County Attach complete site plan on paper not ss thark, x 11 inc i ize. PI must include, but not limited to: vertical and ntakY~f AF direai n and Parcel I.D. / percent slope, scale or dimensions, o rice t nearest road. (ai' t7 Y ICE Please print all information. Reviewed Date Personal iM a n you y be use fo econ a purposes (Privacy Law, s. 15.04 (1) (m)). (Q / 3 Property Own U10- Property Location B~A Govt. Lot ! 1 /4 r 1 /4 S Z T O N R E (o W Property Owne s Maili Addre Lot # Block # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village o Nearest Road New Construction UsOI<Besidential / Number of bedrooms Code derived design flow rate yy't GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood //Plla__i~cn- elevation if applicable ~ Q ft. General comments Rj- and recommendations: G~ uC System Type System Elevation J ❑ Boring t-- d0'/~vn~CG!/ 0 Boring # ® pit Ground surface elev. /Ul1 . sft, Depth to limiting factor ! in. Soil Appli 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 2-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 s S s /al 3-17 Effluent #1 = BOO > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 6' ~L z Z- 715-246-4516 Property Owner _ P cel ID # Page of Boring # ❑ Boring E t~ I pit Ground surface elev._-;,ft. Depth to limiting factor -'7"`- - in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. n 'Eff#1 'Eff#2 2 10-36 11f, -51Y Gv a a Boring # ❑ Boring ❑ pit Ground surface elev. ff. Depth to limiting factor 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 'Eff#2 Boring # ❑ Boring F-1 ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg1L and TSS >30:S 150 mgll- ' Effluent #2 = BODS < 30 mg/- and TSS < 30 mg1L I 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. SOD-8330 (R.N00) 5-i d~A_ 3 P 3 U.Soil Test Plot Plan Project Name Oevering Homes Sha Bird Address 1433 Cernohous Ave New Richmond Wi 54017 /STM #226900 Lot 16 Subdivision Richmond Acres Date 6/7/12 NW 1/4 SE 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 Survey Iron System Elevation 96.5/96.9 *HRpSameasBenchmark B M. * Property Line f7sojeornw Scale is 1" = 40' unless otherwise noted 80' 7% Slope 15' B-1 40' 70' 10' B-2 30' 100.5' B-3 101.5' 100' Pro 3 Bedroom House Property Line 116th St. 8O' RADlU.' '89'56'03"E 5225.30'- - DRAINAGE Spp~y'y3 rlr EASEMENT Ea S 7.18 , UPON m 1949.68' 177.00' 527.08' ,1 `N Q+ z 0. o~w yo 974. ey 1 ~Col L4~tow 2.12 acres - , wQ Con L4 92,174 sq. ft. z L. B. 0. 975. 0 H. WE. =97J a • g goo' $ 589'56'27"W 521.07' V V r 220.00' 301.07' j • r 1.94 acres 1V o 17 CO 4 AG1 tl Cn 1r, /o01. Parcel 026-1294-16-000 06/13/2012 02:45 PM PAGE 1 OF 1 Alt. Parcel M 28.30.18.1498 026 - TOWN OF RICHMOND Current ❑ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 11/10/2005 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner 0 - RICHMOND ACRES LLC RICHMOND ACRES LLC 7935 STONE CREEK DR STE 10 CHANHASSEN MN 55317 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1348 116TH ST SC 3962 SCH DIST NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 2.120 Plat: 10-086-RICHMOND ACRES LOTS 3/49 026-05 SEC 28 T30N R18W PT NW SE RICHMOND ACRES Block/Condo Bldg: LOT 016 LOT 16 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 28-30N-18W NW SE Notes: Parcel History: Date Vol/Page Type 11/10/2005 81173 10/086 PLAT LL c- 2012 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 04/30/2012 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 2.120 400 0 400 NO 10 Totals for 2012: General Property 2.120 400 0 400 Woodland 0.000 0 0 Totals for 2011: General Property 2.120 22,700 0 22,700 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 Total 0.00 0.00 0.00 r '3E+641 U 2814P 5 MAT REGISTER OF DEEDS ST. CROIX CO., WI DOCUMENT NO. WARRANTY DEED RECEIVED FOR RECORD 06/03/:2005 12:00PH WARRANTY DEED EXEWT # This Deed, made between David A. Ball and Kimberly A. Ball, husband REC FEE: 13.00 and wife and Dennis F. Ball and Nancy A. Ball, husband and wife, TRANS FEE: 3185.40 Grantors, and Gerald J. Smith, a married person, Grantee, COPY FEE: CC FEE. WITNESSETH, T a a e consideration PAGES: 2 convey to Grantee the following described real estate in St. Croix County, State of Wisconsin:: RETURN TO: Parcel 1: The East Half of the East Half of the Southwest Quarter Loberg Law Office (E'/. 359 West Main Street /E'/2 Ellsworth, WI 54011 /SW%) of Section Twenty Eight (28), Township Thirty (30) North, PID #026-1082-40-000 Range Eighteen (18) West, Town of Richmond, St. Croix County, 026-1082-70-100 Wisconsin, EXCEPT Lot One (1) of Certified Survey Map filed April 026-1082-95-000 24, 1990, in Vol. 8 of C.S.M., pg. 2199, as Doc. No. 457843, being 026-1083-10-000 part of the Southwest Quarter of the Southeast Quarter (SW'/,/SE'/.) 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'/2 /SE'/,) 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 (SW'/,/SE'/.) 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; 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'/,/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 NO'01'41" East 262.00 feet; thence S89'59'15" 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 comer of the Northwest Quarter of the Southeast Quarter (NW'/./SE'/.) 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. This is not homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; And grantors warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions, covenants and conditions and will warrant and defend the same.