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HomeMy WebLinkAbout012-1019-80-255Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal informatioM! y ~ provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Kwak, Jin Erin Prairie, Town of CST BM Elev: Insp. BM Elev: BM Description: /ao ~~ ~ GS TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic / ~ _~ ~ L~. ~ ~j} / Z5 Aeration Holding TetiK ct=TReCK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~~ ' c ~ J / y / ~J ~~ Dosing Aeratio Holdin PUMP/SIPHON INFORMATION Demand .GPM TDH Lift Friction Loss System Hea ITDH Ft ~~., Ti r,t~ h f)iT a_ ~ Dist. to Well I SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length ~ Z DIMENSIONS SETBACK SYSTEM TO P/L INFORMATION Type Of System: ~ ~~a~~ ~ County: St. CroiX Sanitary Permit No: 479428 0 State Plan ID No: Parcel Tax No: 012-1019-80-200 SectionlTown/Range/Map No: 07.30.17.98A20 STATION BS HI FS ELEV. Benchmark ~ 3: rS X03, i /ab ~,,. 1 sd- ~, c~ • 9 Bldg. ewer ~ ~ ~ J ~ ~ co c~~ , v~G D 7 SUHt Inlet 9 ~ 7 q 3• ~S SUHt Outlet 9 `$ J J ~ 7 . 3 J Dt Inlet `,` ~ Dt Bottom ~ ~~ Header/Man. 7~-7 ~ ~ ~ ` Dist. Pipe ~ ~' ~ ~Z Bot. System ~ v Final Grade .L 1 ~ ,, q7 St Cover ~~ ~\ ~ Q ~ ~ e 3S ~ ¢ ~ ,~ 4'/ •75 -, ~ ~~.1 leo.45 ~.~ 93.~~ ENSIGNS INo. ~~ LEACHING CHAMBER OR UNIT NIJ ~ RIOV ~ IV~r v ~ v~ ~ d Header/Manif ~m Distribution x Hole 'ze a` x Hole Sp Vent to A' Inta i s~ ~ ~ q ~ 1 Pipe(s) Spacing th Dia~ L \ ~` Dia Length _ eng .7VIL VVYGR O JC rr~55WC aya~cn~a vrny Depth Over .... ........... ~. .._ _.__ xx Depth of _ _~___.. xx Seeded/So ded xx Mulched ver ~ Depth Bed/Trench Center ~ Bed/Trench Edges \ Topsoil ~ Yes [ ~ No "' Yes `~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspectlon ~c i ~ Location: 1683 150th Street iHammond, WI 54015 (NW 1/4 NW 1/4 7 T30/N 17W) NA Lot 2 Parcel No: 07.30.17.98A20 1.) Alt BM Description = F~ ~ ~ ~~^ G~a ~'~' ~ ~a~s a y' 2.) Bldg sewer length = ~' ~ -amount of cover = 7 '~ Z + I Plan revision Required? (]Yes No C ~ If ~ ~p ~ ~, Use other side for additional informs ion. i ~ ~~ ~ ~S ~- -- ~ Date Insepctor' Signat Cert. No. SBD-6710 (R.3/97) '~\ turer. % (~iX umber: ~1 ]r J~-a ~E30t-! C~ I ~. Z,'~ ~, ~ Safety and Buildings Division County ~ S ~ 201 W. Washington Ave., P.O. Box 7162 ~X : ~ ~ ` Madison, WI ..53707 - 7 Sanitary Penmit Number (to be filled in by CoJ ~~~0~~,~ (608)266-X1.5-1 ~t~~'' Department of Commerce Sanitary Permit Application ~~ • • ber personal infotimation you pro ide Wis. Adm. Code In accord with Comm 83 21 ~ , . , ~ ~ may be used for secondary purposes Privacy Law; ~15:04(1)(m) rej~~A~ddress if different than mailing address) Lh C JJ I. Application Information -Please Print All Information RO/k C ~~ M ~' ~ ~ ~~ ~ ~~O U INA ~,~~ ryT Property Owner's Name - el # Lot # ~ Blo # l ` -~ ~ ~ ~ ,,,~ Property Owner's Mailing Add~•r~ess~ ~/,~ l ~J v ~ " -" `'~~ ` Property~Location "F/ %~~ Section City, to ~ Zip Code Phone Number r ~ ~ ~~ (:fit ~ ~~© ~ ~ ~~ircl ne) ~ N; E r W ll th t a l ) k f $ ildi h II T ad s i pp y ec a a pe o u ng (c . t~ ~rrte ~ or 2 Family Dwelling - Number of Bedrooms ltM s • ^ /~~~ : ~ Q~' Public/Commercial -Describe Use ^ State Owned -Describe Use City_ Villa ship of ~ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) ~(Z - /D/9 - ~ - ZUO . 9$~ -ZO A' New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration - Plumber Owner IV, a of POWTS S stem: Check all that a l Z 2 1 0 i Non -Pressurized In-Ground ^ Mound >_ 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-G and ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) j ~3L,. e-f.~'L V. Dis ersaUTreatment Area forma n: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elev tion ~' ~~~3 e ~~ ~ ~J ~ ~ f VI. Tank Info Capacity in Total Number / Manufacturer Prefab Site Steel Fiber Plastic 1 Concrete Constructed Glass Gallons Gallons of Units W, ~ New Existing ~~ Tanks Tanks Septic or Holding Tank ~- Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersign ssume responsibility for installation of the POWTS shown on the attached plans. Plum is Name (Print) Plumbe ' ~gnature MP/MPRS N/umbce~r Business Phone Numb/er ~~~ ~ ~ ~ ` G~ ~'~~ ~ . b (7 / J 1,G rte/ j% i', Plumber's Address (Street, City, State, Code) ~ / / , / VIII. Coun /De artment Use Onl Approved ^ Disapp Sanitary Permit Fee (' Ludes Groundwater Date Issued Issut Agent Signatu (No Stamps) 1~ ~ Surcharge Fee) r y/~~ 3~~ . 29r ~D ~ " ^ Owne eason enial 'f-r' ~t T n L', ,,, ~„ ~~ IX. Conditions p r al 31 ,/y~„ „ ~ C SYSTEM OWNER / / ~ ~( %W~~- ~~ : ~...~- ' ~ ~ 1 Septic tank, effluent filter and ~J9~"^~` .~ ~ tL ~ ~~J C°S I,t, y . o ~ dispersal cell must all be serviced /maintained ~ ~~ \ as per management plan provided by plumber. / 2. All setback requirements must be maintained as per applicable code/ordinances. Attach~camplete plans (to me county Doty) for me system on paper nvucaa .~.... o.~~ . ,. ~) SBD-6398 (R. 01/03) P OT PLAN PROJECT Jin I<wak ADDRESS 1691 150th St. New Richmond ~ 54017 i~11N 1/4 fVW 1/4S 7 /T N/R 17 W TOWN Erin Prairie COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE8/20/05 BEDROOM 4 CONVENTIONAL XXX IN-GRO D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE OLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 28 ENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A-100 BOREHOLE O WELL *H.R.P. Same as Benchmark Well is to meet all SYSTEM ELEVATION 91.5/91.3 4.5' below grade setbacks required by WDNR Scale is 1" = 40' unless otherwise Vent noted >6„ Standard Biodiffuser of Cover I-eaching Chamber with 31.1 ft2 of Area 11" 6' Long ,~ „ Grade at System Elevation Pro Town Road to 150th St. Plans Designed Using Conventional Powts Manual Version 2.0 Pro 4 Bedroom House 25' 1 ST ..~r~ 25' 349' Property Line 1% slope 2-3' X ~8' Cells with >3 0 ~,._ ~ O of enough slope to establish contours (~ 250' Property Line ~-~s ? B- 1' ents 20 ~I 1 POT PLAN PROJECT Jin Kwak ADDRESS 1691 150th St. New Richmond Wi 54017 NW 1/4 NW 1/4S 7 /T N/R 17 W TOWN Erin Prairie COUNTY ST.CROIX 8/20/05 BEDROOM 4 MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN-GRO D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 28 ENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A-100 BOREHOLE O WELL *H.R.P. Same as Benchmark Well is to meet all SYSTEM ELEVATION 91.5/91.3 4.5' below grade setbacks required by WDNR Scale iS 1" = 40' unless otherwise Plans Designed Using Vent noted Conventional Powts Manual Version 2.0 >6„ Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area 349' „ Property 6' Long 11 Line " Grade at System Elevation Pro 4 3 4 Bedroom House 25' Pro Town Road to 150th St. ST 25' B- 1% Slope 50 2-3' X 88' Cells with >3' Spacing B-3 50' Not enough slope to establish contours 250' Property Line U-'~ ~..~~~- ~s ?i B-2 ~- r.,15; Vents 20 ~,- 4' Wisconsin Departmentof Com~ter~ Division of Safety and Buildings Attach complete site plan on paper RECEIVED ATION REPORT Adm. Code ~ County ~ ~. • r. ,~ / 3n must Page of indude, but not limited to: ver5cal and horizontal reference point (BM), direction and parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Revi ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ ~ Q 5 Property Owner Property Location 2 D n~ ~~ Govt. Lot ~j~(J 1/4 /4 Tc~~ N R~ E ( r) W Property Owner's Mailing Address Lot # Block # Subd. Na or CSM# ~ 1 Svc. s ~ • ~' City State Zip Code Phone Number ^ City ^ Village Town Nearest Road New Construction U ~ Residential /Number of bedrooms Code derived design flow rate ~ GPD ^ Replacement ^ Public or c mmerdal -Describe: ______ _ ~/_y _ Parent material ~l~J~, -L~/L'G~ Flood Plain elevation if applicable j~~J f/ ----'----- -- ft. General comments ~~~~ Pi ~~tiC~li 9!~ J~ 9 / i '~ and recommendations: l -' ~' Boring # Boring /~ pit Ground surface elev. ° ~ ~ ft. Depth to limiting factor ~ in. / _ Soil ication Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~z D ,- 3 ~. T----- s .~- ~ l 2 -z l6 ------ ~~ ~ L ®~~ # O Boring 1 ,/~ Pit Ground surface elev. ~ ®; l7 ft. Depth to limiting factor .~ l (7 in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 C~~1 L ,- 3t ~--~--_ ~ I ~ S ~ 6 < r! i~ 'Effluent #1 = BOD > 30 < ~0 m9/L and TSS >30 < 150 mg/L 'Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signs CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Ev nation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~~ ~~ ~--~ 715-246-4516 #-~ '> . Property Owner Parcel ID # Page of © Boring # .~ Boring/ ~ ~ / it Ground surface elev. ~ ` _ ft. Depth to limiting factor ~ in• Soil lication Rate H ri De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfI? zon o p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 Z -z -- r ~ b ~r ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor ~n• Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell t]u. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 •Eff#2 Boring # ^ Boring ~J ~ U Pit vrounasurraceeiev. ~~. ~N~~ u, ~~~~~~~~~y ~a,,..,~ .. Soil ica6on Rate th D t Color i D Redox Description Texture Structure Consistence Boundary Roots GP D/ff Horizon ep in. om nan Munsell - Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODE > 30 < 220 mglL and TSS >30 < 150 mglL 'Effluent #2 = BODS < 30 rng/L and TSS < 30 mglL 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 (R.6/00) i ., Soil Test Plot Plan Project Name Ronald Beauvais Shau rd Address 1691 150th St. .°' New Richmond Wi 54017 C #226900 Lot -1 Subdivision -------- N W 1/4 N W 1/4S 7 T 30 N/R17 W Boring 0 Well PL Property Line BM or VRP Assume Elevation 100 ft. Township ErinPrairie County ST. CROIX Top of Steel Fence Post System Elevation 91.5/91.3 *HRpSameasBenchmark Date 4/24/05 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 Contin ency Plan ption #1. If ystem fails, determine cause of failure, use alternate area 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 715-246-4516 St. Croix County Zoning 715-386-4680 Pumper Tom Mondor 715-246-5148 Shaun Bird #226900 ST CROIX COUNTYC,rREEMENT SEPTIC TANK MA ~ ~ O~gg,,cHIp CERTIFICATION FORM r^, . ~ ./ OwnerBuYer ~~ ~~ ; ~j `l U~ ~ Mailing Address r .~ ~G~---- o ~,y Address 3 ` 5m Planning p ent for new constnictt°II) Pr P aired fro De aitm. (Verification req Parcel Identification Number ~ty/State LEGAL D~CgIpTION `n ~~~~ ~, ,Town of ~-=-- ~/, ) ~/,,~~ . T~N-R ProperfY I,ocali ~ ~ ~ Lot # _______.- IIV~ ~" Subcli'vision ~--- Page # ~-- Volume Certified Survey Map # go~~R°/ 2gr, ~ Page # _.._1-' - ~.~~(~~ Volume -# ^ no Lot lines identifiabl Spec house ^ Y ~° to handle wastes. Proper mainte~~ SYSTEM r~rENANCE of your septic system could result in its premature failure ou ut into the system improper use and nii~intenaii~ ears or sooner, if needed by a licensed pumper. What y P out the septic tank every three Y the yvaste disp°s~ system. ~~'~ °f pumPi>ig tic tank as a treatment stage iui r ~ by a can meet the function of the sep by the oovne t a certification form, signed ~ syy~m ter • wastewa disQo to submit to st. Croix Zoning ~ ri fy~ ~t (1) the on srte ~ of sludge. 113 The PmPem' °~ lumber, restnctedplumber or a licensedPumPeT the septic tank is less than mastesPlumbez; JourneymanP 2 after inspection and pumping {if necessary), is in proper oPe1a~ condition and/or () with the staa~~ the private sewage disposal systemmin. ~{rcation ements and agree to maintain State of Wisco Uwe, the undersigns h'a`ve read the above requu' the Department of IZatural Resources, Zo~g O~~ within 30 set forth, ~~ ~ set by the Depai~~ °f CO~e1ust be completed and returned to the St. Croix County stati»g that your septic system has been maintained of the year eXpirafion date. ~ ~y / [~~ DATE GNA OF APPLICANT our knowledge. I {we) am (are) the owner(s) o~ OWNER CER'I`IFICAI'YON I (we) certify that all statements on this formdeed~r corded in Register of Deeds Office. ~ p operty described above, by virtue of a warraIIty~ ~^ '~- DATE (l~• OF APPLICANT ent. *«**~ GNA unit being revoked by the Z.oninS Depart «:s«:« Any information that is mis-representedmay result in the sanitary Pe tad warranty deed from the Register of Deeds offic tho warranty decd «« include with this Application: a s if reference is made ~ a copy of the certified survey map tli 286? P 181 STATE BAR OF WISCONSIN FORM 3-'1998 Ronald D. Beauvais and Diane L. Beauvais, husband and wife, quit- claim to Jin Koo Kwak and Tabatha J. Kwak, husband and wife as survivorship marital property, the following described real estate in St. Croix County, State of Wisconsin: A parcel of land located in the Fractional NW'/. of the NWY, of Section 7, T 30N, R17W, Town of Erin Prairie, St. Croix County, Wisconsin, further described as follows: Commencing at the NW corner of said Section 7; thence S00°59'22"E 322.08' along the West line of the Fractional NW'/, of the NWY< of said Section 7 to the computed NW corner of that Certified Survey Map filed in Volume 3, Page 769 in the St. Croix County Register of Deeds Office; thence N89°00'38"E 299.00' along the computed North line of said Certified Survey Map to the point of beginning; thence continuing N89°00'38"E 814.46' to the East line of the Fractional NWY of the NWY. of said Section 7; thence S00°32'06"E 489.46' along said East line; thence S89°00'38"W 810.58' to the computed Southeast corner of said Certified Survey Map; thence N00°59'22"W 489.44' along the East line of said Certified Survey Map to the point of beginning. The grantors also convey to grantees an easement for ingress and egress over the following described property: The South 33 feet Lot 1 of CSM filed in Vol. 3, page 769, located in the NWY.-NWY, Section 7, T30N, R17W. 5103499 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX C,O. , MI RECEIVED FOR RECORD 08!15/2005 02:00PM OUIT CLAIM DEED EXEMRT l; 8 REC FEE: 17.09 TRANS FEE: COPY FEE: CC FEE: PAGES: 4 Name and Return Address l~r~/~~ .y~v sue`/o 9 072-1019-80-200 Parcel Identification Number (PIN) This is not homestead property. ~~R -~) ~ . r2~ 1~ _----_ __~: __ ~ c~.-~ ,~~_ ~ ~ ct~,~--~-,~ . Dated this .. l~ day of , 2 05. -_ *Ro Id D. Beauvais `Diane L. Beauvais AUTiriENTICA(T~ION Signature(s) ~,_ U t1a ~ d O • YJ p 4 V' Ct ~ S authenticated this ~~1L t~ ®~S day of ~///JJ~~usf' , 2005. ~ ~-~ Kam. • ~ d n a ~d L . Si ~e i- TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Ronald L. Siler VAN DYK, O'BOYLE & SILER, S.C. 201 S. Knowles Avenue New Richmond, WI 54017 (Signatures may be authenticated or acknowledge. Bolh are not ACKNOWLEDGMENT STATE OF WISCONSIN ) )ss. St. Croix County ) Personally came before me this ~_ day of ,~- , 2005 the above named - ~ t/~Q%~ to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. ~ ! V s;; otary Public , St a of Wisconsin My Cost;mjs~n is perman2Ont._ ~f not, ~ j ' U 2867P 182 AGREEMENT This Agreement is made this f~ day of August, 2005, by and between Ronald D. Beauvais and Diane L. Beauvais (hereinafter referred to as "Beauvais") and Jin Koo Kwak and Tabatha J. Kwak (hereinafter referred to as "Kwak"). WHEREAS, Beauvais own a parcel of land approximately 9.129 acres in size which is legally described in the Trustee's Deed recorded on September 9, 2004, in Volume 2649, page 382, Document No. 773424; and WHEREAS, Beauvais wishes to convey a two acre parcel of the above- described property to Kwak which is located in Southeast corner of said property; and WHEREAS, the current subdivision ordinances for the City of New Richmond prohibit Beauvais from subdividing the above-described property in order to create the two acre parcel to convey to Kwak; and NOW, THEREFORE, for a valuable consideration, it is agreed as follows: 1. Beauvais shall convey the entire 9.129 acre parcel to Kwak following the execution of this Agreement. 2. As soon as the parcel is able to be subdivided to create the two acre parcel in the Southeast corner, Kwak shall file the appropriate paperwork in order to subdivide the property. 3. Upon the creation of the two acre parcel, Kwak shall convey the remaining 7.129 acres back to Beauvais at no cost to Beauvais. 4. Kwak may only mortgage the two acre parcel in the Southeast corner of the property. Kwak shall not allow any liens to be placed on the remaining 7.129 acres. U 2867P 183 5. Kwak shall not be able to sell the property before it is subdivided down to the two acre parcel without the prior written consent of Beauvais. 6. In the event that Kwak does self the property, all proceeds above the appraised value fair market value of the two acre parcel (including any buildings) shall be given to Beauvais. Dated this is day of August, 2005. Ronald D. Beauvais Diane L. Beauvais STATE OF WISCONSIN ) )ss S~ ~ ~`~ ~ ~° COUNTY ) Jin oo Kwak Tabat a J. Kwak 0p Personally came before me this ~s day of August, 2005, the above named r~Unq(c~ 0..BPGNVa,; , to me known to be the persons who executed the foregoing document and acknowledged the same. ~ ~~~~~~ ~n4 id c. s,i~,. Notary Public a`~~.~ ~ S~~ St. Croix County, Wisconsin ~~ ~~'~, My Commission Expires: r ~0'~ p1RY ~,~ PU ~~ .~ ~ i ~ ~N~~~~\'~n '••..~ta of WAS .••`' u zss~P ~s~ STATE OF WISCONSIN ) )ss COUNTY) Personally ca a before me this day of Au ust, 2005, the above named nown to be the persons who executed the foregoing document and acknowledged the same. Notary Public St. Croix County, Wisconsin My Commission Expires: ~l~/0~ This Instrument Drafted By: Ronald L. Siler Van Dyk, O'Boyle & Siler, S.C. 201 S. Knowles Avenue New Richmond, WI 54017 ~~~ ~~ ~ J ~ .. ''••. Yoe 1:3~-~kc~~3{~- DOCUMENT NO. STATE BAR OF WISCONSIN FORM 3-1982 QUIT CLAIM DEED Louise Forrest, a single person, quit claims to Louise Forrest as trustee of the Louise Forrest Revocable Living Trust dated September 16, 1998, the following described real estate in St. Croix County, State of Wisconsin: Part of the Northwest Quarter of the Southwest Quarter (NW 1/4 of SW 114) of Section 6, Township 30 North, Range 17 West, tying Southerly of the Willow River. i~ ~~0 '~i9~2$3 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 1E-22-1996 9:30 fW IM DEED ~ EXEMPT M 16 CERT COPT FEEa COPY FEE: TRANSFER FEE: RECORDING FEE: 10.00 PA6'ES: 1 REMINGTON LAW OFFICES The Southwest Quarter of the Southwest Quarter (SW 1/4 of SW 1/4) 126 S. Knowles Ave. of Section 6,.Township 30 North, Range 17 West,EXC.EP_"Cthe_ B.o, sox-1~7. following two parcels: New Richmond, WI 54017 1. Certified Survey Map recorded in Volume 3, page 612; and 2. Highway GG. Tax [D Nos: The Northwest Quarter of the Northwest Quarter (NW 1/4 of NW 1/4) 012-loll-30-000; ol2-to17-so-ooo; of Section 7, Township 30 North, Range 17 West, EXCEPT the o12-1019-80-000; 012-1020-10-000; following five parcels: 012-1020-30-000;012-IO2o-ao-ooo; o1z-1020-so-000;012-IO2o-60-000 1. A parcel described as follows: Beginning at a point located 130 feet North of the Southwest (SW) corner of the Northwest Quarter of the Northwest Quarter (NW1/4 of NWl/4) of Section 7; thence North 80 feet; thence East 347 feet; thence South 210 feet; thence West 19S fcet; thence Northwesterly to the point of beginning; 2. Certified Survey Map recorded in Volume 3, page 612; 3. Certified Survey Map recorded in Volume 3, page 769; 4. The West 300 feet of the Northwest Quarter of the Northwest Quarter (NW 1/4 of NW 1/4) lying South of Certified Survey Map recorded in Volume 3, page 769; and S. Highway GG. The Southwest Quarter of the Northwest Quarter (SW1/4 of NWl/4) of Section 7, Township 30 Nor~t1, Range 17 West. The Southwest Quarter (SW 1/4) of Section 7, Township 30 North, Range 17 West. This is homestead property. Dated this SAN day of December, 1998. 04. d-r~u.e.x.~ ~D~o.-~t.~~--' (SEAL) ~` LOUISE FORREST ACKNOWLEDGMENT THIS INSTRUMENTS WAS DRAFTED BY Judith A. Remington Remington Law Offices 126 S. Knowles Ave. P. O. Box 177 New Richmond, WI 54017 (715)246-3422 STATE OF WISCONSIN ) ss. ST. CROIX COUNTY ) Personally came before me this ~ day of• ~" " 1998 the above named Louise Forrest to Wti .. _ to be the person who execute the foregoing instrument and acknowledge the same. f ~~ ~ 7 ith A. Remington No Public St. Croix County, WI My commission is permanent. Parcel #: 012-1019-80-200 08/2912005 03:59 PM PAGE 1 OF 1 Alt. Parcel #: 07.30.17.98A-20 012 -TOWN OF ERIN PRAIRIE Cufrent ' X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 09/03/2004 00 0 Tax Address: Owner(s): O =Current Owner, C =Current CaOwner O -BEAUVAIS, DIANE L DIANE L BEAUVAIS 1691 150TH ST NEW RICHMOND WI 54017 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: 9.129 Plat: N/A-NOT AVAILABLE SEC 7 T30N R17W PT FRL NW NW; COMM NW Block/Condo Bldg: COR SEC 7; TH S 00' E 322.08FT ALNG W LN FRL NW NW TO NW COR CSM 3/769; TH N 89' Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) E 299.OOFT TO POB; TH CONT N 89' E 07-30N-17W NW NW 814.46FT TO E LN NW NW; TH S 00' E 489.46FT; TH S 89' W 810.58FT TO SE COR more... Notes: Parcel History: Date Doc # VollPage Type 09/03/2004 773427 2649/394 TD 09/03/2004 773424 2649/382 TD 12/22/1998 594283 1389/230 QC nnne ~~ ~sese n ov Bill #: Fair Market Value: Assessed with: 0 Valuations: Description Class Acres Land Totals for 2005: General Property 0.000 0 Woodland 0.000 0 Lottery Credit: Claim Count: 0 Certification Date: Last Changed: 04/20/2005 Improve Total State Reason 0 0 0 Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 U 26y9P 39y I STATE BAR OF WISCONSIN FORM 7 - 2000 Document Number TRUSTEE'S DEED Roberta A. Steel, Shannon M. Mattison and Lyan T. Forrest, Jr., as Trustees of the Louise Forrest Revocable Trust dated September 16,1998, for valuable consideration conveys without warranty to Roberta A. Steel, a married person, Grantee, the following described real estate in St. Croia County, State of Wisconsin (ifmore space is needed, please attach addendtun): See attached. This deed is made pursuant to the Court Order attached hereto. '77347 REGISTER OR DEEDS sr. cROIx co., wI RECEIVED FOR RECORD 09/03/20@4 10:10A1I TRUSTEES DEED EXEIPT # 11 REC FEE t 17.00 TRANS FEEL COPY FEE: CC FEE: PAC3ES: 4 Recording Area Name and Retum Address Thomas R. Schumacher Bakke Norman SC PO Box 54 Baldwin, WI 54002 Dated this l 7 day of Au rt , 2004 . •Lynn T. Forrest, Jr., Trustee AUTHENTICATION Signature(s) of Lynn T. Forrest, Jr. authenti ed this ~_,_ day f _ August ___ _ -_ , 2004 - * Bre t R Johnson _` _ ` _ _ y TITLE: MEMBER STATE BAR OF WISCONSW (If not, ___-- -_____~ authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY __ __ Brent R Johnson , ___ Lommen Nelson Law Firm -Hudson, Wisconsin (Signatures may be authenticated or acknowledged. Both sre not neceaasry.) Parts of 012-1017-50-000: 012-1020-40-000 Parcel Identification Number (PIN) Q• • Roberttt A. Steel and Shannon M. Mattison, Trustees ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. ST. CROIX County ) Personally came before methis -L day of Au zest , 2004 the above named Roberta A. Steel and Shannon M. Mattison, as Trustees of _ _ the Louise Forrest Revocable Trust dated September 16,1998 to me known to be the person(s) who executed the foregoing instrument and acknowledged the Notary Public, State of WtS GCwA r. ~ A~ __ _ My Commission is permanent. (If not, state expiration date: * Names of persons s[gning in soy capacity moat be typed or printed bebw their signature. INFO-PRO (soo~ss2ait www.tatoprotorms.com STATE BAR OF WISCONSIN TRUSTEE'S DEED FORM No. 7 - 2000 ~~ U 26y9P 395 STATE OF WISCONSIN CIRCUIT COURT ST. CROIX COUNTY Lynn T. Forrest, Jr., as Trustee of ~~~ e~- the Louise Forrest Revocable Trus `i 1677 150th Street ~ New Richmond, WI 54017, AUK 1 1 OF Plaintiff, and Diane L. Beauvais, Adrienne Oillmaa, Aubrey Mattison, Janunie Mattison, a minor, Nell Forrest, a minor, Caroline Forrest, a minor, Brenda Turner, Rodney Forrest, Estate of Donavan L. Forrest, Cathy Ausen, Cathy Smith, David Steel, Tom Steel, Tabatha Kwak, and Scott Beauvais, Involuntary Plaintiffs, vs. Roberta A. Steel, as Trustee of the Louise Forrest Revocable Trost and Shannon M. Mattison, as Trustee of the Louise Forrest Revocable Trust, Defendants. ORDER No. ~ ~, V J ~ J Judgment: 30701 FILED AUG 1:7 ~ ClER1(pF sr ~~ This matter came before the Court on July 8, 2004, upon motions by the parties. Plaintiff Lynn T. Forrest, Jr. appeazed in person and with counsel, Brent R Johnson; Involuntary Plaintiff Diane Beauvais appeared in person.and with counsel, Michael Brose; Defendants Roberta Steel and Shannon Mattison appeared in person and with counsel, Peter M. Reinhazdt; and other Involuntary Plaintiffs appeazed in person. The Court having reviewed the file, the motions filed by the parties, and the stipulations of the parties HEREBY ORDERS AS FOLLOWS: U 2649P 396 1. The Court approves the Map of Survey introduced into evidence at this hearing as Exhibit 1 and hereby orders the creation of Lots 1 through 4 as designated on the Map of Survey and the legal descriptions attached to the Map of Survey. Lots 1 through 4 designated on Exhibit 1 aze, without the necessity of further action or proceedings, conveyed to the respective beneficiaries as follows: Shannon Mattison shall receive Lot 4; Roberta Steel shall receive Lot 1; Diane Beauvais shall receive Lot 2; and Lynn Forrest shall receive Lot 3. 2. The lots referenced in the paragraph above shall be created and conveyed for purposes of executing the terms of a will or court order, in accordance with St. Croix County Land Use Regulations § 18.05(A)(1). ~'~- Dated this ~ ~ day of August, 2004, nunc pro tunc July 8, 2004. BY OURT: -- Hon. Eric J. Lun ell Circuit Court Judge St. Croix County, Wisconsin U 26y9P 39? ADDENDUII~ TO TRUSTEE'S DEED PIN: Parts of 012-1017-50-000 and 012-1020-40-000 GRANTORS: ROBERTA A. STEEL, LYNN T. FORREST, JR. AND SHANNON M. MATTISON, AS TRUSTEES OF THE LOUISE FORREST REVOCABLE TRUST DATED SEPTEMBER 16,1998 GRANTEES: ROBERTA A. STEEL Legal Description A parcel of land located in the Fractional SW 114 of the SW 1/4 of Section 6 and the Fractional NW 1/4 of the NW 1/4 of Section 7, T30N, R17W, Town of Erin Prairie, St. Croix County, Wisconsin further described as follows: Commencing at the SW comer of said Section 6 (also being the NW corner of said Section 7); thence N00°54'43"W along the West line of the Fractional Section 6 462.53' to the Southerly right-of--way line of County Trunk Highway "GG"; thence S65°57'41"E 329.30' along said Southerly right-of--way line to the point of beginning; thence continuing along said Southerlyright-of--way line 565°57'41 "E 674.14 ;thence continuing along said Southerlyright-of- way line Southeasterly 6.74' along the arc of a 851.51' radius curve concave to the Northeast whose chord bears 566° 11' 18"E 6.74 ; thence continuing along said Southerly right-of--way line 502°20'34"E 13.55 ;thence continuing along said Southerlyright-of--way line N87°39'26"E 29.26 ; thence continuing along said Southerly right-of--way line Southeasterly 177.83' along the arc of a 851.51' radius curve concave to the Northeast whose chord bears 574°34'03"E 177.51' to the East line of the Fractional NW 1/4 of the NW 1/4 of said Section 7; thence 500°32'06"E 295.25' along said East line; thence 589°00'38"W 814.46' to the computed Southeast corner of that Certified Survey Map filed in Volume 3, Page 612 in the St. Croix County Register of Deeds; thence N00°59'22"W 645.30' along the East line of said Certified Survey Map to the point of beginning, containing 372,917 square feet (8.561 acres) more or less. Subject to easements and restrictions of record, if any. 08130/2005 23:40 7157491719 NORTHLAND SURVEYING ,:,~ r,r' ... ~ ~~:: PAGE 02 • "a/~ ~~KiL BEG7IQV 6 I.ALIMIWI CAP Fw~D ) ~ LE6END ~ ~• - ~ jtTloN cbRr~T MorAMENT ° Sia F a c A o • - M11CF~l.35' (OIfT510E bIA.) IRON ~ A~oICA 1" k t,• ( wTSIO6 DIA.) i MEIGHLJG 1.l3 L95, / LIN. ~ FT~ Y ° ~~ \ ~ fi S x •w~-~- - IPDxCATES FBNLE ~ \\ . 6RORHIC SCALE 1"d300' 0 300 600 900 9EARIN©5 FIEFERENCF3a TO TI-~ WEST LINE •OF THQ'FRACTIONAL NW!/A OF SHCTION 7. ASSI.M~p TO BkAR NOo~59'22"M ; PFlCVZOUSLY REC AS So3°03'E). NOTE: NO New PARCELS HAVE HEEN CREATED THE ~~~ ~ ~b ~., N•7°AO'4B'E 71P9.52' ~ ~ gSY.IA' ~' s NpRTFI LINE OF THE ~CT7flNAL ~ ~ ':1 ~ ~ Swl/~ o~ TFA• SMS/1 C7 ~ ~ TFIEA9TERI,Y SLOE Q ~ CGNTAIN$ L~1pp0~Mp~AI=M~TEI..Y Q W Q J a ~~' EO[~.Agi'~5 TO THE MATEIIS ~ S2 ~ ~ ~ ~b m r ~ .y,~ "' ~ - - ~~ 8.854 AOaEg TO °Q ~a MEANOEA 1. ~~b 1S ~~ A(~4R0)%IMATE~ (~ H~~ MATER& EDGE .~ ~ u•S~aI s• ,, OF THIS MAA 'AND SURVEY IS To AND MARK 7HGSE PORTYaNS OFSCwn ThE ADDEb TO THE ABSTRACTS Uf TIf ' PERSPEC'T'IVE OWNERS BUT NO DEEDS Wlll BE FILED Op RECORDED AT THIS TIME. NOTE: r1aE NUMBEpg IN THE PARCELS shawa HeReaN coRResr+oNO TO rHE 1Jl~3Eg5 SFbWr1 oN THE vzSTRIBUTSON UPON DEATH" PORTION aF THE lOUISE FORF~S7 REYQCABLL .LIVING TRUST OATEC) SEP. !6. 1998. THESE NLJM~aAS AR<? NOT lOT NUFIBERS. HOWEVER NUMBEgS ARE USED FOR REFEREN~ TO DESCRIBE TF£ PARCELS As SIiDWN ON THIS MAP. CURVE. L~FO)'iAAT1DN CUHvE 3 GAVE Z ~'+ADILIS-~ Y6~ 1' i~XUS- 8515!' p; 2.907 ACRES CENT 027'!3• CENTRAL ANIii.E~ 1A5756- ~ R ARL IET~O1TFl~ 6.74' ARC ~&NG~N177.83' l ~3~, °i X11 P0.9SI8 P1i0POSED p ~ e/~, L~J FU• 'CERTIFIED , SLIivE MAP OR LOT LLI ~ ~ I ° ~~ 3Tj)o SIlO YISION ,.: N ~ - ~ oia~'~ ~ cARAr,E ~ 2.752 ACRES ~~ 'Ly ~ ~ I ~~~ ~ ~ ~ sip ~' O W ~` ~ ~~ 1.1E p~ ~°37y p ~m I ;,S ~. ~._ `c+~..ti ~~ I ~ T'aw' swi//~ coR,~ _ sFcTTw 4 I I ~ 81654' ~ FGi2°20'34'& ~ ~N91~,~2G'6 l44o,8e_ T I Ne7°~~~ R.R. sax. FW+a ~ ` ~` Pourv2 I f NaRTri LINE OF YFIic ~AACTIONA~ ^, . p ~ NW7/A OF SECTION 7. N97°3g'26"& N!/1 CORNEtR, ~cTTr`~InR~~i ~ I I ZrAAA~P TA za~5' , sECrsaN 7 f\ I ; .J(tN.$T R~09FATA 8551 ACi£5 ~,' / S~ ~~ ~~~5`1~1'