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HomeMy WebLinkAbout026-1126-35-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division L INSPECTION REPORT sanitary Permit No: 453059 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, Raymond Richmond Township 026- 1126 -35 -000 CST BM Elev: Insp. BM Elev: BM Description: _ Section /Town /Range /Map No: / e c c `� 12.30.18.796 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 1C ��j /0b Dosing Alt. BM Aeration i Bldg. Sewer Holding St/Ht Inlet ` ZZ T. 77 TANK SETBACK INFORMATION SUHt Outlet • �I . S TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ Septic 7 - ' 5 c ' 1 39 ; N :" Dt Bottom \ Dosing Header /Man. Aeration Dist. Pipe , Holding Bot. System 9� PUMP /SIPHON INFORMATION Final Grade Manufa Demand St Cover GPM 3. Z(, odel Number H Lift Friction Loss em Hea TnH F t Forcemain eng Dia. Dist. to Well = , SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length No. Of Trenches PIT MM ENSIGNS No. f Pits Inside Dia. L DIMENSIONS 3 g® - �� SETBACK SYSTEM TO D P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR 492- t' Li Type Of System: Q 1 � UNIT Model Numb DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake 4 Pipe(s) ` ` ` \ Length ZD Dia Length Dia Spacing \ SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx De of 7 Seeded /Sodded xx Mulched Bed/Trench Center Bed /Trench Edges Topsoil \ \1 Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1404 166th Avenue New Richmond, WI 54017 (SW 1/4 NW 1/4 12 T30N R18W) Water's Edge Lot 35 Parcel No: 12.30.18.796 c,� 1. Alt BM Description = o 2.) Bldg sewer length = 2- \ � bUd\ A, - amount of cover Plan revision Required? Yes No Use other side for additional information. SBD -6710 (R.3/97) Date Ins ctor's Winature Cart. No. Safety and Buildings Division County *'�^ 201 W. Washington Ave., P.O. Box 7162 S 1 , vo i C Virsconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266- 151 Sanitary Permit Applicatio R - VE an I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information ou provide may be used for secondary purposes Privacy Law, s15.04(1 m) M roje Address (if different than mailing address) I. Application Information - Please Print All Information `d �� � 4 4 Proper Owner's Na me w t ,':� Par 11/ Lot if Bloc # Pro rty Own 's M ailing Address Property Location D 1 3� f City, State Zip Code Phone Number — w+ t /4. NW 'k,Section 1 L � D p C ( *ircle PIN) II. Type of Building (check all that apply) � S T N; R E or V� or Public /Commercial - Describe Use CS; 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number t CJ V''�i v2 ; ` � Cl ❑ State Owned - Describe Use r - ❑Cit _ illage If wnship of Q(� r - —_ III. Type of Permit: (Check only one box on line A. e_o&phig line B if applicable) A. New System y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System B. El Permit Renewal El Permit Revision 11 Change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner 1N. Type of POWTS System: (Check all that apply) 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- Ground ❑ Holding Tank ❑ Peat Filter g*c l niL Recirculating Sand Filter Ems• 1 ElRecirculating Synthetic Media Filter El Leaching Chamber ❑Drip Line Gravel -less Pipe xplai V. Dispersal/Treatment Area Information: 6V(_0 ' V ZZ ► o EJ Des* Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation S ®0 1 .a VI. Tank Info Capacity in Total Number Manufacturer Prefad Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks ptic r Holding Tank robic Treatment Unit Dosing Chamber VII: Responsibility' Statement- I, the undersi ed, as a responsibility for ' n of the POWTS shown on the attached plans. P ber's Na T(Pri Plumber's i gnatur /MP Number Business Phone Number Plumber's Addre ss (Street, City, State, Zip Code) � 9 �A I "I A U _.e N t C� VY\ 0 A il VIII. County Department Use Onl Approved ❑ Disapproved Sanitary Permit Fee •ncludes Groundwater Date Issue4 Is in gent Signa re o Stamps) Surcharge Fee) p3 El Owner Given Reason for Denial Z5V � Q IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All Setback requirements must be maintained as per applicablO code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size �SBD -6398 (R. 01/03) ia�ma� d J , Po L«kQ, m ti ssb v-� sc� ` y� N w y s' -a 10.50' S :� %is Q�sl`�` 1e�c�v�no n 1 s?` Croce e t , ` c� ( 4' Gp y� 1AJ m = rt � ��. 1 P ,c, P rte' E 00, 4 ry 8' � 3 / 33 � o WcS L.v.o- Elmo, m N hi - 4+ 35 JAjoy 8(h TCIIO 10 F- ! r�-c UCH% (" c1 Ca ��s2,p cab ►r�� -3s ��� .� d p !a � y Iry Q O t gD ` � a � / 3 3� Wisconsin Department of Industry SOIL AND SITE E V A L U AT` R E P Q F Page 1 of 3 Labor And Human Relations Division ofrSafety 8 Bu ildin g s 1 1 Adm. Code in accord with ILHR 83.05, � 1� r V , Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. muse, but t. Cr oix not limited to vertical and horizontal reference point (BM), direction and °/ ope, scale or ,� � C L I.D. # dimensioned, north arrow, and location and distance to nearest road. ��� ndin APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATIO _ ��, 5� 'p �F"GE ED BY DAT cP , o Foo 9 zo PROPERTY OWNER: � (,d L 7 - � ON Derrick Const. Inc. G t /4,S 12 T 30 N,R 18 f[(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # D. NAME OR CSM # 1505 Hwy #65 35 na 1 W acTbR �S CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [3rOWN NEAREST ROAD New Richmond, WI. 54017 715) 246 -2320 Richmond I 140th St. [xJ New Construction Use [x J Residential / Number of bedrooms 4 [ ] Addition to existing building ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate 5 bed, gpd /ft • 6 trench, gpolft Absorption area required 1 ZOQ bed, ft _ l0.00,trench, ft Maximum design loading rate __ d, gpolft f ) __ trench, gpolft Recommended infiltration surface elevation(s) �� 96.00 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRE 7RE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for s stem o S 1:1 U RI S U CAS ❑ U ®S ❑ U m 7 SYSTEM U ❑ S 6cl U SOIL DESCRIPTION REPORT C,�6 AjUU , J ], 26M k-or 14 Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft Boring # Horizon in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends ......1.. 1 0 -10 10 r 2/2 none 1 2msbk mfr Cs lm .5 .6 2 10 -22 10 r 4/4 none sici 2msbk mfr CTV I if .4 .5 Ground 3 22 -34 7.5 r 4/4 none sl 2msbk mvfr gF if .5 .6 •5' elev. 99, ft. 4 34 -90 7.5 r 4/6 none ms osq ml na na .7 .8 _ Depth to / limiting factor 3.2 +90" Remarks: Boring # 1 -9 10yr 2/2 none 1 2msbk mfr cs if .5 .6 °' 2 2 9 -27 10 r 4/4 none sici 2msbk mfr gw if .4 .5 �{ Ground' 3 27 -34 7.5 r 4/4 none scl 2msbk mfr QW if .4 .5 elev. 4 34 -56 7.5 r 4/4 none cos osg mvfr gw na .7 .8 ' } 1 _ Depth to 5 56 -80 5 r 4/4 none sl 2msbk mfr gw na .5 .6 S" limiting 6 80 -90 5 r 4/4 none ms OS9 mvfr na na .7 .8 •� factor + •z ZL L 71 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200 ye. New Richmond, WI 54017 Signature: Date: 6 -16 -2000 CST Number: m02298 II I - -- PROPERTYOWNER Derrick Const., Inc. SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # Mndinq r , Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -9 10 r 2/2 none 2 9 -24 10 r 4Z4 none sici 2 bk mfr Uw if .4 .5 Ground 3 24 -34 7.5yr 4/4 none sl 2msbk mvfr 9w na .5 .6 elev. 99 ft. 4 34 -90 7.5 r 4/6 none ms oscl mvfr na na .7 1.8 ' Depth to limiting factor f +90" Remarks: Boring # 1 - 5� 2 10 -26 10 r 4/4 none sicl 2msbk mfr qw if .4 .5 •`� Ground 3 26 -33 7.5 r 4/4 none sl 2msbk mvfr aw if .5 .6 S elev. 4 33 -86 7.5 r 4/6 none ms osq ml na na .7 .8 •� 9 9.6 ft. Depth to limiting factor +86" Remarks: Boring # 1 0 -15 10 r 2/2 none 1 2msbk mfr qw 2m .5 .6 2 15 -29 10 r 4/4 none sicl 2msbk mfr Cfw 2f .4 .5 Ground 3 29 -36 7.5 r 4/4 none mvfr if .5 .6 elev. 4 36 - 82 7.5 r 4/6 none ms OSQ mvfr qw na .7 .8 9 9.5 ft. Depth to 5 82- 6 7.5 r 4/6 7.5 r 5/8 ms os m1 na na .7 .8 limiting factor �Z Remarks: ring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Derrick Construction, Inc. 1554 200th Ave. CSTM2298 SW4NW4 S12- T30N - R 18W New Richmond, WI 54017 MPRSW -3254 town of Richmond (715) 246 -6200 lot #35- Brushy Mound Lake This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. mil" =40 , = top of 1 pvc pipe @ el. 10 00 t . i. = top of 1 pvc pipe C el. 99. , 30P r 1 All � o' v C�v Gary L. Steel 6 -16 -2000 �. � ! � � J � = 'f� :�•= E �� - Ci - a _.y `w V om LOf 34 - AI!III<rI� I , - 111'IIIi X11:1111 •��/ �. \lei \1' •i� 1.9 992.9 • AC • IP ��_ � ���.�,�► •.. _ �C� aril � T.: � � s R te- yh n r� EZ1203 -_ 3 R s tt = Ri . V �R ►wR j 4 -62RR 12 Iry • ! ►��i' R �� 112 Cc- ww. ow f R !! r f �'g1oQ� vw C to _ (p ) t � O.p. eta - APr Y a �'*�'° •, s s aX. �+ P- mar ft- Nift1Aft Arft v ow -el ` • E3 . ( v2 R / f ' ? F. a is S. St }. F IY °+KSRtic `7rh"'°c" - ' ' + F+�'ta n '' ' s rK _ f•ri +c+c[ t Rw1 w 4O �! TR tiq A rea ar �a#ew �erw c snewscvs ., �� .y i lf �� qf �, �� � �11+�y,: { # � (`.' �a _'_.- "�..._. } �efiO�R �. � ; -� SY•r`1. t[ J6 I 00 fptr7 ._ms (t F7 o f rwy ' SQ. F(. wheRR x}.4,12 . ay1 Frgc* A rra"_`� - �t�F ft. }tblxr_ sY 4p r a.7rs-vfalc,..yr„�araza3 "yF�RL Y6 X to T FZ 1 203, Lj rr f s$ Ina, i In Stu lamo i i PowTS O WNER'S MANUAL &MANAGEMENT PLAN of StmWOCA 41.E pg} 1►TM PT7: cturar Owner o r" EE DOW Q Holding Vo l. O Q gat f P © 0 NA k MMt� gal 61L PAPJ M E,"M 0 0 DOW Hot** vol- 9 " 0 G} NA Number of � NA uPurm Finer M� C) ✓� `� c� Nexnber of Pt*&c FacOW Units Fitter Model r� — QZ,1� - Es t>roeted iaveragel flaw (� "A Dew (peak) flow = (Estimated x 1.5} sfact�r hip Mode l 501 Appiic$410" Rate u nit Standard Oualy monthly SwuVeraval Fitter ❑ Peel Filter Fats. ON A Grease (FOG) 530 rngfl 0 N� Aeration 0 Wetland giochmrsicsi rn DaarW (BoD } 5220 mg& Q NA Q DWN* dm Q Other' Total ceded Sonde ass) 5160 m9A- Manufacturer 0 NA pretrested Effflrrent thOtY Monthly avwaAe C6g s} Biochemical oxygen Demand (13001 530 men- Grourrxl lgr�Y) Q in-Ground tPr �} Total � Sow (TS,+} 530 sngfl- ❑ NA O Mound Fecd COMO" 1"Motric mean►} S10'` cfuJll}Orrr! At -Glade Q Drip-� Q Other. Maximum Effluent Particle Size Ys in dia. D NA ❑ NA 0 NA 0 N and ` trunk effksmc. +Ysiuss typk±al for dorrrestic vvaetewater �� MAtIMTENAMCE SCHEDULE Service � Swnfte Event s1 � 3 Vows) ©NA At best once avwW -- ) tropect condition of tardcts} g , combined slud aril scan eat one Vard (VP of tank volume 0 NA of tsnkls} When the high water atanm ins activated Pump out cis ❑ rnant! i(s) ' lMexhnum 3 ors) 0 NA trope" dispersal ceps? At best once every: mdt#tlsl 0 NA clew affluent filter At bast once aviary= p rnortithlsl 0 NA controls & alarm At least or" every: C1 } ,aspect lip pump DNA D fs1 Rush laterals and a test At most once ems►. 0 NA Q rnorMd�ls} At leant once *very= D NA pygy'pUCTfOi1lS or cacti#icatrons. WmaNTENAHM ,� of the following tir:enses t of tanks *sad cells shalt be made by aintainW. SWU66 Swv'&* Operator (p rack of M f p}r or hardware an cracks or Restricted Sewer; POWTS lrerector• identify y Master pectin of the tsnkls} to identify of effluia t on the gMum .any nag broken . T inspections moat i � and scorn and a check for any tack up or P and to check for affil at the observation i a am bake. measure the volume to check the effluent levels con dition surface. The � CORW shall be surface. The visually WO � of affluent on the grog surface "my p�png of effluent on the of the local �aority th requires the immediate nom °n ! �.t}rird (Y3) or more of the tank volume, of and scum teak equals of in sccordance try M c hapter NR 113 When the combined accumulartion in any trea'"Ant Ong operator and entire contents of the tank shall be removed by a retreetmer Wisconsin A&Wniafifatlsra Code. undo or urized components other sar*rices. irachiding p AN but not timitad to the serv i c ing of effluent filters. y POWTS Maintainer• units, and any swvica+g at intervals of 512 months. shall be performed b a ca of of any service event. A service report be Proms to the local regu authority within 10 days of � GMW (2107 I Pageof START UP AND OPERATION For new construction, Prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals that may impede the treatment process and/or damage the soil dispersal COW- i f high concentrations are detected have the contents of the tanks) removed by a saptage servicing operator Prior to use. System start up shag not occur when sal conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cells) in one large dose and may overload them resulting in the backup or surface discharge of effluent. To avoid thus situation have the contents of the pump tank removed by a Septege 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 pork 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 swag degreasers; dental floss; diapers: disinfectants; fat; foundation drain (strop pump) discharge; 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 sups shah be taken to insure that the system is property and safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • 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 replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a re cement soil absorption system. The 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 sou 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 MAY CON TAIN 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 13E DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POYVTS INSTALLER POWTS MAIN TAINER Name Name Phone - T ( . s j-3L S Pho1e SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Plane '7 (S ..3 8'(.� . This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies in compliance with chapter Corn n 83.2212Hb)11)(d)&(f) and 83.5411 t. (2) & lal, Wisconsin Administrative Code. . t ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer f Mc t� D �. d s M i r44 Mailing Address f o �K Q Property Address 14- 4- I (Verification required from Planning Department for new construction) City /State L" 0 -A6 Parcel Identification Number 5 " LEGAL DESCRIPTION Property Location 2� %,, /,, Sec. ' . T N -R 1'9 W, Town of 1�t L44 yLlio 00 Subdivision WA TIG" Lot # -? C' Certified Survey Map # , Volume , Page # `--' Warranty Deed # �' , Volume C' z , Page It -274 Spec house ❑ yes Xno Lot lines identifiable Kes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature tailure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeymanpl*nber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the abo *e requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification . stating that our septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of ee year e iration date. SIGNATLT4& OF APPLICANT DATE OWNER CERTIFICATION I e) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pro descri d a by a of p warranty deed recorded in Register of Deeds Office. 1 � z� SIGNA OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed N C ; 96 i I r I i Oel It 1 3 1 d gi � \ / A \ N ✓�, OZ i ,,..� � 1 1 �' � x � /, d9 I. Ok J o I / pl � ! �� � • 1 1 .,ij I JI QI OI Uj� f:.. I ..0- �/ _ 'b..`,ix `/ /• x ?66 a6. 0 3 1 I I 1 1 I I x" 1 I N x � 1 0 0 In I � • 1 � i \ � 9 6 I �I I C �1 I P c0 p / O I d. I 1 ,. 1 LL 1 1 x LL /• l fi r. 99� I x i I —i fit A 00 ' ILID' U, 2522P 3y 75599 Document Number WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS THIS DEED made between Brushy Mound Partners, LLP, a ST. CROIX CO., WI Wisconsin Limited Liability Partnership ( "Grantor") and Raymond J. RECEIVED FOR RECORD Smith or Lois L. Smith, Trustees of the Raymond J. Smith Trust alaedSep ember 15 2003, ( "Grantee "), 03/08/2004 10:00AN WITNESSETH, that the said Grantor, for valuable consideration conveys to Grantee the following described real estate in St. Croix WARRANTY DEED County, State of Wisconsin: EXEMPT # REC FEE: 11.00 TRANS FEE: 108.00 Lot Thirty -five (35), P of Waters Edge in the Township of Recording AreCOPY FEE: Ric mon , roix County, Wisconsin Name and Ret d PAGES: 1 Brushy Mound Partners PO Box 445 New Richmond, WI 54017 026 -11 126- 35400 (Parcel Identification Number) This Is not homestead property. Grantor, Brushy Mound Partners, LLP, a Wisconsin Limited Liability Partnership, is an affiliate of Derrick Homes, LLC, a Wisconsin Limited Liability Corporation. Grantor develops land and Derrick Homes, LLC is a home construction contractor. Grantor agrees to sell this lot to Grantee on the condition that Derrick Homes, LLC will be the builder of the home for Grantee. If Grantee does not commence construction with Derrick Homes, LLC as the contractor /builder within two (2) years of the date of sale of this lot to Grantee, Grantee gives Grantor the irrevocable right to re- purchase the lot for the same price as Grantee paid Grantor for it when Grantee bought it from Grantor. If Grantee desires to sell the lot to another purchaser before constructing a home upon this lot, Grantee gives Grantor'the right of first refusal to re- purchase the lot for the same price as Grantee paid Grantor for it when Grantee bought it frorn Grantor: Dated this 5th day of March , 2004. �r " =(5e ichael R. Stevens AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ST. CROIX COUNTY Personally came before me this 5th day of March , 2004, the authenticated this _ day of 19_ above named Michael R. Stevens and Ronald L. Derrick, as partners of Brushy Mound Partners, LLP, a Wisconsin Limited Liability Partnership to me known to be the persons signature who execut a foregoing instrument and acknowledge the same. type or print name HWI L L TITLE: MEMBER STATE BAR OF WISCONSIN No taw Not ut9 (If not, State of W authorized by' 706.06, Wis. Slats.) type or print name Heidi L. Lutz Notary Public St. Croix County, Wisconsin. My Commission Expires: March 26th 2006. THIS INSTRUMENT WAS DRAFTED BY Brushy Mound Partners 'Names of persons signing in any capacity should be typed or PO Box 445 printed below their signatures. New Richmond, WI 54017 a Lamm 8 s e- QWW Na.rmwt A .0 • 56t + -t /4 . 3C Man AN "0Iq Located In part of the SW 1/4 of the NW 1/4, part of the NW 1/4 of the NW 1/4, end +cwt. w 4.17 Pein4i pw port of the NE 1/4 of the of the NW 1/4, the SE 1/4 of the NW 1/4, the NE 1/4 a SK 1• . 44• y „y. �9 of the SW 1/4, port of the NW 1/4 of the SE 1/4, and part of the SW 1/4 of the ot.a of 1 Po,�d. i. NE 1/4, all in Section 12, T3014. R18W, Town of Richmond, St. Croix County, Wisconsin. o Fam9 t' Ir.n PIP. AW PARK, LL-P. MM 1K PNMS SOM ON 1125 YAP ARE BUBA= 10 STAIL CQM1T NO YOM SW 9u" Setbeck LM (+OD' Fran RAM 11kY Nia 06 LAVAL NaBta AND RECILKAT10N5 Ob ME7LANDa NMwM LOT BIB. AOCM TO PARCEL. ETC.} BtffQE PUPWA71N0 OR OE . AN1' PANCIEL, CONTACT VE Sr. OM a01MT• C Fran Nvdg, OwwLaw �� .. w. 20NN9 OFFICE AND TIE AM71WItlATE 7011 BOAIO FOR ADVILL, Pr.po..d 01wra.7 - Le.otp, Appoc ... - Da,etw n @I __ Ewna,to Y- FFbW P1 BBONW r7� pr CRY of New ! UB,NAENT I y " �/ Al oarotw WNUWW " Pa s CA N. R. E High watw GmtIon y ` 61 N N. R L "0 watr LM. 4'o d I (too ran R C L K) w"M 0 at 4. JAIL /�- �.��".'_ .r•"' I All 6 7 R Ded9�(A5w C I AL AL LOT so ': ANiw T7 MIOIBie ` w %.,;•. QIS?.?....... 1'... 1143 ea FT. ' G .1111 2 { ipE 130. .. s17t Asa_ %., ST CPO*X t2. 00 S4 FT. " LOT JI zBSAoES .................. a' ZONiNGof -` LOT .17 + +- Y9 AREA 10 11MM 0 "3 ACRM r 05.315! So. FT. An 10 ISLANDER LANE: v J \ r 7.413 AoRFS �, BUM S0. FT. LOT s o 741, 00� teTANCEI LBes g t.ee Aorea 1i u15m EAtawn• r S0. FT. LOT -- - - A 4.7 * t 1.70 ACRES as 1 �� e+as4t m FT. yn.. 1.96t AGES +5 OF y feE.40• + +c�o t S�aR {° AMU 110 MEANDER LM _ 1 �" ".to' \ AWA 70 tAYNOER €' 1. A . 07.045 s4 FT./ S, 5 H 1.50 ACRES +N t�� .'i" 101RL NFX / / / / •.......• DaL AIE{e_ /`�� d6 0. FT. / / - � � F.� ISO AMES 150.0 �ytdN / • . .. 11.07+ s ' - "'{{{ /// ,� LOT 1 Q !F� Arc �i, � r[B ! T7TAL AREA '�I' ' / WTAL S0. FT. 'r mTA A e FD M. I ' / I ,/ 1.00 ACRES., i�i \ \•.. 110.1P4 S0. 'T_ F.F.E 091.0 �` I ••''• 9 F E _ \ 2LMLE 97S3 / `..�•7C FLw.L at Its IS&49r Lor46 X 1.90 ACRES 0 r27 J K 1.9 3 54 FT. W.E. 097A / 1.05 ACRES �! • • y p / ® \�\ ' 0.6J' // / F.F.E. 110.0 N8nr44'E tB4.73 / /' mTALNEk _-- ---!'' / 04.974 S4 FT. 194 73 Q / i \ 'i• 1. ACRES N@0%r44'E b° ' F F. 996.0 d EE 960. •'•'•. H.W.L. HwE. 957.1 , XM ARE& f , LOG � O r a o st M745 ft FT. o � rS y \ AAA: 1.07 ACRES 04371 SO. FT. 64,930 511. FT, InRQ�. ' F.F.E. BB0.7 F N ACRES & • \ F.FE. 6M 1 ACRES �+1 341 Df Lmr or eE' Sur 1 or AF NN' + 'e tiS ; - NUi� • x• 16437 tl79,h• -- • ' 1•' SCALE N FEET•. t C SC E TOB l..t ! .p BEARINGS ARE REFERENCED To TIE VEST LIM OF 'RE NWTHMEST QUARTER OF SECTION T4. T.3014 ., RiSB. THCH O-ASSWED TO BEAR N0O4104'! Rua Y kollZMEM M O U 0./p ST. CRUX WOlT• QAM POSTIONINO SYSIEN NETNONf MCV"ENTS. LAKE SHEET 1 OF 4 S!