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018-1043-40-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 572840 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: Rode Trust, Donald H. &ShirleV I Hammond, Town of 018-1043-40-000 CST BM Elev: Insp.BM Elev: BM Description: Secbon/Town/Range/Map No: /o 6 oO ,0 /00 '() a411- * 2 u2 .'p 19.29.17.3018 TANK INFORMATION 1n -) ELEVATION DATA 20 b /Z)7 3 TYPE MANUFACTUROV nV4 3 CAPACITY STATION .B HI FS ELEV. 4 /OG o >- Septic / Benchmark �• /d ZAP Dosing Alt.BM �- 1� —147 A"Tt n- y)t. I OC Bldg.Sewer (F,.'7 /e3 -"3—/ Holding SUHt Inlet 7,52 16z. gr-7 p� TANK SETBACK INFORMATION SUHt Outlet 7 U /OZ 7 TANK TO P/L ti WELL BLDG. Vent Air Intake ROAD Dt Inlet 5 °17 Septic r [�/�,' r Dt Bottom Dosing /67 7 16D _ Heade an Dl, Aeration 50,3 4-L-,, Dist. Pipe Holding Bot.S I9 �� 75.3 /D�•� Ok Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover ' / 7 .3 26-, (t/ GPM Z` Ia�� y7 / �jI Model Number C5"3 � 3 J 3 , ( �9 -�`� TDH Lift, Frictions�� System Head 5� TDH�,Z� Forcemain! Lengtk, Dia. I/ Dist.to Well / �� — SS Z r/ SOIL ABSORPTION SYSTEM BED/TRENCH Width f I Length t No.Of T riches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS QQ//]I SETBACK SYSTEM TO P/LS JBLDG WELL LAKE/S L NG Manufacturer: INFORMATION MB OR Type�OyS ste�y m: Z�r S �M r � UNIT Model Number: DISTBIBqTION I/S(Y�S^/T'nE�MO/- He er/Mani Distribution r / �� x le Size x Hole Spacing r Ven to Air Intake Length Z . Dia / Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of r/ xx Seeded/Sod d �� Mulche Bed/Trench Center �� Bed/Trench Edges Topsoil N� �' Yes E] No .Yes No I COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1:—LL/ /Inspection#2: L Location: 836 160th Street Hammond,WI 54015(NE 1/4 SE 1/4 19 T29N R17W) met Fol, Parcel No: 19.29.17.301�N� �/� �1.)Alt BM Description=2.)Bldg sewer length= 3u' � � Ill z5l/y 4jePHc +aa 5D -amount of cover i Plan revision Required? [] Yes �o T Use other side for additional informatiddn>,. Date Inse or's ature Cert.No. SBD-6710(R.3/97) PUMP PERFORMANCE CURVE PUMP PERFORMANCE CURVE EFFLUENT MODELS . PASSING CAPACITY MUM M3MIWZM= NON■■■■■o®off°°o°o■�o®oo°°o°o°©° ■■■■■■■o°°e°°eo°°®oo°000°v°v° ■■■■■■■,�®e°°ee°°°sole°e°°ev°°° ■■■■■■■''ow .' ■■\■■■■' „ °°a°°vee°e°e°°see°�s�■° .■,` �°®°ae°vise°see°°eiv°ee°° \\\\\'Na■■r■■■■■■■ W\■\I\\■■■■■■■■■ ■►■111 ■\■■■■■■■ oaom 000 n�\\il����■■■■■■■ 000m°m°a°e0m0o0o°©0 ��■■11■�■■■ ■■■■■ mo0oov°a°aom0v®0°© f■�■I�■�■■■��■■■■■ WIN o©0omvo°©v�o0ov0 °°©0 \\\►11��■■ESN'■■■■ ® 000 0°®0000mvoo0 ■��\1111►\■■■��■■■■ °so0oo© ®m°°m°©0 aaea0vaao°o0®0v0 i \■\1\W EINI M■\\■■■ aaaaaaaa®®©oo0v0 � �� � °vaieaaa�aa°eaeavv \\��II►�\\■�■■■■■■ eeea°sae°a°ass0° ■■�!�1�\I\►■■■■■■■ .... ■■\\\12101\�11►\�■■■■� a3.' subjected ©©ovo®�°ovvoov0mvvovss00vv mvv0000v000vvvoo©o�oss©omv ®0v©000°ovv0v000vvvomv0v°v :. N■■MM■omsassvomoovvv©ovov©oov©vv o0sssassssaso0oo©ovvoo°®°° oms_s_s_s_s_s_s_s_s_sas_s_s_o_v_©oovvvvo ,�■■■■o©°ss°s_°s°as°s°s°ss°s°s°sue°s°ss°s°s°s°svvov NOTE:For Pump Performance on Model 112,Industrial column explosion proof pump,see FM021 9. WORM SEWAGEAND DEWATERING n�.�■.�■■■■■■■■■■■■■■■ mom MISM, �■�.m\�■■■■■■■■■■■■■ YEN.■■■■.■►'WE■■■■■■■■■ r\\N\■■\ON■O■MONO■■■ ME No . . mom No -' �■V�7■■O■N.�■■■■■■ ONE m subjected to less than 15 feet TDH. County Safety and Buildings Division ST 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) °a✓ Ma isol 3 f-_7_162 V". S Transaction Number Pry Permit Application 3 �f 3 1.In accordance with SPS�$ s.Adm.Code,submission of this form to the appropriate governmental unit is required prior to obz,, a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,s.15.04(1)(m),Stats. IbbWW`` I. Application Information-Please Print All Information Property Owner's Name Parcel# 0 0- 1 ae.. 016 - J043 - J/D - 000 Property Owner's Mailing Address Property Location I �-> 3 g 3 �p ilv o ST Govt.Lot City,State Zip Code Phone Number 1/., S I= '/4, Section R a.lnlr w o Ad S`t o 1.5 71 S- 977 - 19 3 7 � (circle one T�_N; R _Eol II.Type of Building(check all that apply) Lot# 1K 1 or 2 Family Dwelling-Number of Bedrooms �- �( / Subdivision Name Block# ❑Public/Commercial-Describe Use • �4 I. � -'- L '_"� ❑ City of ❑State Owned-Describe Use CSM Number ❑ Village of 16 o 3 t f Jr Town of N o, rr ti,m o-h• d III.Type of Permit: (Check onl one bog on line A. Complete line B if applicable) A" New System Replacement System ❑Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner W.Type of POWTS System/Component/Device: Check all that appl,, ❑Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound?24 in.of suitable so XMound<24 in.of suitable soil ❑Holding Tank E)Other Dispersal Component(explain) ❑Pretreatment V.Dispersal/Treat ent Area Information: A yu, rft4J1_,1,1,1 G" ('') t"". Design Flow(gpd) Design Soil Applic ' Rate(gpdsf) Dispersal Area Re used(st) Dispersal Area Pr posed(sf) System Elevation ySe , t>; Aso it L� ��� t3,3, /a o . 9z. VL Tank Info tapacity it Total #of Manufacturift Gallons Gallons Units 4.P U° y New Tanks Existing Tanks Septic or Holding Tank U o 0 o o U W i p�yL Dosing Chamber VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the PORTS shown on the attached plans. Plumber's Name(Print) Plumber's Signature MP/MPRS Number Business Phone Number 6,"O-L.t',-R N44 M V rL.L. F_ q '. �z7 Zt o �S- -7 If 3;Z Plumber's Address(Street,City,State,Zip Code) 9�'7 W & * R � C>�� VIII. oun /De artment Use Only pp roved 11 Disapproved Permit 7Feeee OD Date Issued ❑Owner Given Reason for Denial S 6P` �• IX.Conditions of Approval/Reasons for Disapproval I SYSTEM OWNER; ':22 L: S� "1� i1 �h G;c%(: 4 � 1.Septic tank,effluent filter anc dispersal cell must be serviced/maintained as per management plan provided by plumber. 2.All setback requirements must be as per app ica o/ggdiptW for the system and submit to the Count/only on paper n t less than 8 m!2 z 1 inches in sizeA )I �� SBD-6398(R.. 11/11) KEITH E STONER Page 2 10/31/2014 Owner Responsibilities: • The current owner,and each subsequent owner,shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure,or component. .Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 This Amount Will Be Invoiced. Gerard M Swim When You Receive That Invoice, POWTS Plan Reviewer,Integrated Services Please Include a Copy With Your (608)789-7892,Mon-Fri, 7:15 am-4:00 pm Payment Submittal. jerry.swim @wisconsin.gov WiSMART code:7633 cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm Walter F Nechville (Plans Mailed To) �T DIVISION OF INDUSTRY SERVICES �yl�9�Yvrp� 3824 N CREEKSIDE LA HOLMEN WI 54636 3 is Contact Through Relay p www.dsps.wi.gov/sb/ w www.wisconsin.gov �ps81 orzt+ti5� Scott Walker,Governor Dave Ross,Secretary October 31,2014 CUST ID No. 224059 ATTN:POWTS Inspector KEITH E STONER ZONING OFFICE KEITH STONER SOIL TESTING SANITARY DESIGN ST CROIX COUNTY SPIA 23220 WOOD CREEK RD 1101 CARMICHAEL RD SIREN WI 54872 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/31/2016 SITE: Identification Numbers Donald Rode Transaction ID No.2453439 836 160TH St Site ID No. 805642 Town of Hammond Please refer to both identification numbers, St Croix County above,in all correspondence with the agency. NE 1/4,SE 1/4, S19,T29N,RI 7W FOR: Description: Three Bedroom Mound System/5%slope Object Type:POWTS Component Manual Regulated Object ID No.: 1500938 Maintenance required; Replacement system; 450 GPD Flow rate; 19 in Soil minimum depth to limiting factor from original grade; System(s):Mound Component Manual-Ver. 2.0,SBD-10691-P(N.01 101,R. 10/12),Pressure Distribution Component Manual-Ver.2.0,SBD-10706-P(N.01 101,R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s)referenced above. CON The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code requirements. AP F No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, POFE of SSI stats. DIVISION OF iN The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders: • A sanitary permit must be obtained from the county where this project is located in accordance with the 41S requirements of Sec. 145.135 and 145.19,Wis.Stats. Pact RR • Inspection of the private sewage system installation is required.Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d),Wis.Stats. • A state approved effluent filter is required.Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required.Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • The area within 15' downslope of the dispersal component shall remain undisturbed.Vehicular traffic, excavation or soil compaction is prohibited in this area. • A copy of the approved plans specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. wasE _ ii 201�� MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Donald and Shirley Rode Replacement Mound Owner's Name: Donald and Shirley Rode Owner's Address: 836 160th Street Hammond WI 54015 Legal Description: Parcel in the NE1/4-SE1/4 Sec.19 T29 N-R17W Township: Hammond County: St. Croix Subdivision Name: Na Lot Number: Na Block Number: Na "TIONA`Ly Parcel I.D. Number: 018-1043-40-000 �RO�D yAND Plan Transaction No.: ,NAL SERVICES Page 1 Index and title BUST Ry SERVICES Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications 4wltcE � Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Designer: Keith E. Stoner �c� �D11►Sj nse Number: Designer 1575-007 Date: 08/20/14 °^ °°��'''•�P Number: 715-653-2324 KEITH E 't a STONER Signature: n.PtW;ir to to they' Mound Component Manual for Pero S[B-10691-P(N.01/01),and both SSWMP Publication 9.6 Design of Pre°ssure.-Distribution Networks for ST-SAS(01/81)and Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N.01/01) Version 7.0(R. 03/2012) Page 1 of 8 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill(D)calculations assume a 300.00 Estimated Wastewater Flow(gpd) Table 383-44-3 in-situ soil treatment for 1.50 Peaking Factor(e.g. 1.5= 150%) fecal coliform of<=36 inches. 450.00 Design Flow(gpd) 5.00 Site Slope(%) 99.50 Contour Line Elevation (ft) 19.00 Depth to Limiting Factor(in) 0.40 In-situ Soil Application Rate(gpd/ffz) Distribution Cell Information 90.001 Dispersal Cell Length Along Contour(ft) = 5.00 Cell Width (ft) 1.001 Dispersal Cell Design Loading Rate(gpd/ft2) 11 Influent Wastewater Quality(1 or 2) Are the laterals the highest int in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) C Center or End Manifold 2.50 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.125 Orifice Diameter(in) 2.33 Estimated Orifice Spacing (ft)= 5.92 fe/orifice 2.00 Forcemain Diameter(in) 68.00 Forcemain Length (ft) Does the forcemain drain back? Y 93.37 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft)x 1.3 11.09 Forcemain Drainback(gal) 7.13 Vertical Lift(ft) 81.14 5x Void Volume(gal) 1.43 Friction Loss(ft) 92.23 Minimum Dose Volume(gal) 0.00 In-line Filter Loss(ft) 31.31 System Demand (gpm) 15.06 Total Dynamic Head(ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 x 1.50 x x 1.25 x 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons/Inch Calculator(optional) Treatment Tank Information Total Tank Capacity(gal) 1000.001 Septic Tank Capacity(gal) Total Working Liquid Depth (in) Wieser Concrete I Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 750.361 Dose Tank Capacity(gal) Pol -Lok Filter Manufacturer 20.281 Dose Tank Volume(gal/in) PL-525 Filter Model Number Wieser Concrete Manufacturer Project: Donald and Shirley Rode Replacement Mound Page 2 of 8 Mound Plan and Cross Section Views T —1/1013 J 6 Pipe. .� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : ......Observation _+ KL•1:L•1•L•L:b•1•L•L•L•1:1:1:1:1.1.1:1:1•L:•.•1:1•L:L:::y4.y.•,:b:1:b:•,:1:1:1:1: .L e4 L T .:.:.r.r.:.:.r.:.r.r.:.r.r.:. r.eve��.:.:.:.:.:,:•r.:.:.r:r'�:c'°'�'�:� ' 1.1.1.1• 1.••.•..1.•,.1.1.1.1.1.• 1.1.1.1.1.1•:•°.•'•L•.•1•.1.4�.. '1:L:'L:•. • A r.:.:.:• r.r.:.r.r.:. 5 r;r:r::.r.r.:.:.:.:.:.:::.:.:.:.:.:.... r•a.r.:.:. . .1...�•.�:ti ti�1�1�L�L�•.�L e1�1� v.....1�1:L�•,e•,�•.�'.�b tip•.�g�1:1.1•yy•• L•1.1v L.1 ti•�e1•L�::•.01�ti�L:'••1••..1.•..4.4.•..1.4.•..1�L•.1.:.....L.:...,.:,.L.1.y..,.L..,.1..,.4 b.1..,.1.1 W C. :I: B : : . . . . . . : : : : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I Mound Component Dimensions A 5.00 ft E 20.00 in H 1.00 ft K gift ft B 90.00 ft F 9.50 in z 10.44 ft L ft D 17.00 in G 0.50 ft J 7.07 ft W 450.00 (ft2) Dispersal Cell Area 1389.71 (ft ) Basal Area Available 5.00 (gpd/ft) Linear Loading Rate 9.00 (ft) 1/10 B Obs. Pipe Placement i I Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.71 (ft) ► G H I _.............. F 1 1.42 (ft)Dispersal Cell 0 Lateral 100.92 (ft)-♦ — Invert Dispersal Cell = [3 :•:•:•:•:•:•.•. D Elevation : :•:•:•: : :•: :•: . .. Contour Elevation 5.0 %Site Slope Geotextile Fabric Cover Shading Key m a T Dispersal Cell See lateral details on 10 Topsoil Cap Q- 1.5 ft 1.•..• •••••L' :ti::•:�::•••4.•..1.•.••. Page 4 for number,size, o f.:.f.:. . :::.:.:.:.:. Q Subsoil Cap 1.•1.1. ,ti••.••.,1.1.••• and spacing of laterals. ASTM C33 Sand `° i° : r. r f.. Laterals are equally .: m 0.5 ft Tvpical t ateral r::; F spaced from the Tilled Layer c :°f' << distribution cell's Y W ti.1.ti:y•••••1•yL••••1.1.1:•• S •r•r. r•:•r•:.:r•:•r•:•: 'y1°•°'y re et°� '.Lv1�b ti.:.b•1.1•e;5.;5.;5��ti 1 © 99 9 0 °ti:ti:�:ti:tifb:ti:::.:4::::�:': ti centerline in the Aggregate * A distribution cell(AxB). Project: Donald and Shirley Rode Replacement Mound Page 3 of 8 Center Connection Lateral Layout Diagram Force main connection via tee or cross to manifold at any point. Laterals are identic al I P S �k. •=Turn-uprwdballvalve or IFX�IEx12 I x12.0 Laterals Morcemaln Sch 40 PVC cleanoutplug per SPS Table 384.30.6 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.39 ft Lateral Length (P) 44.22 ft Orifices per Lateral 19 Lateral Spacing (S) 2.50 ft Orifice Density 5.92 ft2/orifice Lateral Flow Rate 7.83 gpm Manifold Length 2.50 ft System Flow Rate 31.31 gpm Manifold Diameter 1.50 in Total Dynamic Head 15.06 ft Forcemain Velocity 3.201 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and —� SPS 316.300 WAC 4 in.min. Disconnect Tank component is properly vented iz F— Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Capacityl 750.36 Gallons T Volume 20.28 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 19.45 394.49 B 2.00 40.56 C P♦ uml off elevation(ft) C 4.55 92.23 94.29 D 11.00 223.08 D Total 1 37.001 750.36 Dom elevation(ft) 3"Bedding uncler tank. 1 93.37 Alarm Manuafacturer JSJE. Rhombus —� Note: Switches Alarm Model Number I Tank Alert1 containing mercury may not be used in Pump Manufacturer JGoulds —� this system. Pump Model Number EP04 Pump Must Deliver 31.31 1gpm at 1 15.06 ft TDH Project: Donald and Shirley Rode Replacement Mound Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name Powers Sanitation Phone 715-246-5738 POWTS Regulator's Name St. Croix County Zoning Phone 715-386-4680 System Flow and Load Parameters Design Flow-Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow-Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ft' Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Freguency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test monthly Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis.Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis.Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished .- - - - - - - •0 0 0.0.....•... Grade \ 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Donald and Shirley Rode Replacement Mound Page 5 of 8 Mound System Management Plan Pursuant to SPS 383.54,Wis.Adm.Code General This system shall be operated in accordance with SPS 382-84 Wis.Adm.Code,and shall maintained in accordance with its'component manuals[SBD-10691-P(N.01/01),SSWMP Publication 9.6(01/81),and Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N. 01/01)]and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33,Wis.Adm.Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers,access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound,defective,or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s.281.48,Stats. The contents of the septic tank shall be disposed of in accordance with NR 113,Wis.Adm.Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm,the filter shall be serviced if the alarm is activated continuously. Intermittent finer alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment,maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However,if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump(dosing)tank shall be inspected at least once every 3 years. All switches,alarms,and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter,and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic(other than for vegetative maintenance)on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations(October-February)dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS,and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5,30 mg/L TSS,10 mg/L FOG,and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral,and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner,and any levels above 6 inches considered as an impending hydraulic failure requiring additional,more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank,pump,pump controls,alarm or related wiring becomes defective the defective component(s)shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface,it will be repaired or replaced in its'present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media,and related piping,and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 8 Page 7 of 8 ROGOULDS PUMPS Submersible Effluent Pump 3871 EP04 EP05 APPLICATIONS •Fully submerged in high ■EP05 Impeller:Thermoplas- ■Bearings:Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. • Effluent systems ■Casing and Base:Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING superior strength and corrosion • Farms manual operation,Auto- 41 �� • Heavy duty sump matic models include resistance. _ • Water transfer Mechanical Float Switch ■Motor Housing:Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in"C"or 7".) facto ry strength,and durability. SPECIFICATIONS ■Motor Cover.Thermoplastic Goulds Krms is ISO 9W FEATURES cover with integral handle and •Solids handling capability: float switch attachment points. 1/4"maximum, ■EP04 Impeller:Thermoplas- 0 Power Cable:Severe duty •Capacities:up to 60 GPM. tic Semi-open design with rated oil and water resistant. •Total heads:up to 31 feet, pump out vanes for mechanical •Discharge size:11/2'NPT. seal protection. •Mechanical seal:carbon- rotary/ceramic-stationary, BUNA-N elastomers. •Temperature: 104°F(40`C)continuous 140°F(60"C)intermittent. METERS FEET _ •Fasteners:300 series 10 _. stainless steel. a 30---- ,— 5 •Capable of running dry without damage to $ 2.5 Fr components. Zs c Motor: _ •EP04 Single phase:0.4 HP, 6 20 _ 115 or 230 V,60 Hz,1550 RPM,built in overload with c s 15 .. automatic reset. a a •EP05 Single phase:0.5 HP, o EPOS 115 V or 230V,60 Hz,1550 - --- 3 10, 1 RPM,built in overload with EP04 automatic reset. 2 •Power cord:10 foot s standard length, 16/3 1 _ SJTOW with three prong grounding plug.Optional 20 ° 00 10 20 30 40 s0 FPM foot length,16/3 SJTW with three prong grounding plug ' (standard on EP05). ° 2 a 6 8 10 12 n-0/h CAPACITY Goulds Pumps ®2001 Goulds Pumps ITT Industries Effective May,2001 VV��JJ B3871 Page 8 of 8 Sanitary Site Plan For: Donald and Shirley Rode I U eo Parcel in the NEI/4-SEI/4 Sec. 19 T29N-R17W Graph*soak(r"t) Town of Hammond-St.Croix County I Inca - 80 it PIL Wooded Wind Break Existing Drain Field Vent I O Proposed Wieser Concrete moo cal. Existing Concrete Septic Tank Septic Tank w/a Poly-LokPL-525 Effluent Filter -� 105.17' Three Bedroom Home Top of Outlet Pipe=101.58' Soybean Field 2.176Acres Shed A BM#2 I PIL Bottom ofSWngNWHouse Corner=107.31' 103.17' I ' 110,,2.62' • Proposed 4"Conveyance Pipe Sch.40 I Pvc. — I FN#836160th St. tot9r .WELL �_ A nm#3 4% Top of Well Caring=104.97' B P/L Proposed 2" Sch.40PVCF.M. Proposed Wieser 1o0.73' Concrete 750 Gallon 4% Dose Tank Soybean Field Note:Property Owned by family farm easement or out right 100.50' purchase ofpropeny to be obtained. \ \\\ 5% 99.50' Proposed S"x 90'Mound Dispersal cell w/a System elev.of 100.92' \ 98.50' 97.50' A JIM=Top of 11/211 Iron Pipe St on Lot Corner Soybean Field * EW=Same ASSUMED ELEV.= 100.00' Elevation Data BM#2 =Bottom of Siding N.W. Garage Corner Elev. = 107.31' ✓� - r - SOIL EVALUATION REPORT #1231 �3 P Depa and Professional Services Page 1 of 3 Qlo SGaf � Of Keith E.Stoner p `© in accordance with County Attach clomp 1n paper not less than 8%x 11 inches in s17e—Rlaam s Si.Croix include, t16 to:vertical and horizontal reference point(BM),direction and percenpt T.;q*' le or dimensions,north arrow,and location and distance to nearest road. Parcel I•D• Q °018-1043-40-000 , 1 Please print all information. Rev "d ,By Personal information you provide may be used for secondary purposes(Privacy Law.s.15.04(1)(m)). g ` Property Owner Property Location ej i Donald&Shirley Rode Govt.Lot NE1/4,SE1 14,S19,T29N,R17W Properly Owner's Mailing Address Lot# Block# I Subd.Name or C M# f 836 160th Street �L2 -l'nVU-ri.N A'"- City State Zip Code Phone Number ❑ City ❑Village ® Town Nearest Road Hammond WI 1 54015 Hammond 836 160Th Street ❑New Construction Use: ® Residential/ umber of bedrooms 3 Code derived design flow rate 450 GPD ®Replacement ❑ Public or commercial-Describe: Parent material Loess over loamy till Flood plain elevation,if applicable NA ft. General comments Propose a 5 x W mound cell located along trhe 99.W contour with a system elevation=100.92. U and recommendations: c✓ �Y v �✓� �z/zc�Q,tea-h� -- -yt�a(_S�iu -1 Q-a�i��n.�"c� Boring# ring _e 3 -02 F 1-1 .dam, Bo ®Pit Ground surface elev. 96.50 ft. Depth to limiting factor 46 in. ISoil 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 'EfW 1 0-5 10YR2/2 - sil 2msbk mvFr Cs 3f-co 0.6 0.8 2 5-13 10YR5/4 - sl 2msbk mvfr gs 3f-co 0.6 1.0 3 13-20 5YR4/4 - sl 2msbk mvfr gs 2f-co 0.6 1.0 4 20-30 5YR4/4 - sl imsbk mvfr gs 2f-m 0.4 0.7 5 30-46 2.5YR4/4 - sl m/lfpl mvfr gs 2f-m 0.2 0.6 6 46-57 5YR3/3 c2d5YR5/8 sl m mfr gs if 0.4 0.7 7 1 57-65 10YR4/4 saturated s Osg ml - - 0.7 1.6 a Boring# ❑Boring ®Pit Ground surface elev. 98.70 ft. Depth to limiting factor 19 in. 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 *EfW 1 0-10 10YR2/2 - sil 2msbk mvfr Cs 3f-m 0.6 0.8 2 10-19 10YR5/4 - sd 2msbk mvfr gs 2f-m 0.4 0.6 3 19-22 10YR4/4 f2d5YR5/8 sd 2msbk mvfr gs 2f-m 0.4 0.6 4 22-33 5YR4/4 c2d5YR5/8 sl 2msbk mvfr gs if-m 0.6 1.0 5 33-40 2.5YR4/4 m2d5YR5/8 sd m mvfr - if 0.0 0.0 Effluent#1=BODS>30<220 mg/L and TSS>30<150 mg/L vent#2=BODS<_30 mg/L and TSS<3O mg/L CST Name(Please Print) Signature: CST Number Keith E.Stoner 224059 Address Keith E.Stoner Date Evaluation Conducted Telephone Number 23220 Wood Creek rd.Siren,WI 54872 8/30/2014 715-653-2324 SM4330(R 11/11) Propetty Owner Donald&Shirley Rode parcel ID# 018-1043-40-000 Page 2 of 3 F ❑Boring 3 Boring# Pit Ground surface elev. 100.08 ft. Depth to limiting factor 20 in. ® 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 'Ef#2 1 0-10 10YR3/3 - sil 2fsbk mvfr Cs 3f-m 0.6 0.8 2 10-20 10YR4/4 - sd 2msbk mvfr gs 2f-m 0.4 0.6 3 20-25 10YR4/4 f2d5YR5/8 sd 2msbk mvfr gs 2f-nn 0.4 0.6 4 25-40 10YR4/4 c2d5YR5/8 sl imsbk mvfr gs if-m 0.4 0.7 5 40-58 5YR4/4 m2d5YR5/8 sl lmsbk/m mvfr - if 0.2 0.6 Boring ❑ 9 4 Boring# Depth to limiting factor ❑ ®Pit Ground surface elev. 100 82 ft Dep 9 10 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. 'Eff#1 `Eff#2 1 0-10 10YR2/2 - sil 2msbk mvfr Cs 3f-co 0.6 0.8 2 10-23 10YR5/4 c2d5YR5/8 SO 2msbk mvfr gs 2f-co 0.6 0.8 3 23-33 10YR4/4 c2d5YR5/8 sil 2msbk mvfr - 2f-m 0.6 0.8 *Soil field capacity saturated at 23" Boring# ❑Boring ®Pit Ground surface elev. 96.70 ft. Depth to limiting factor 17 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fV in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. •Eff#t 'Ef#2 1 0-7 10YR3/3 - SO 2msbk mvfr Cs 3f-m 0.6 0.8 2 7-17 10YR4/4 - sd 2msbk mvfr gs 2f-nn 0.4 0.6 3 17-23 30YR4/4 c2d5YR5/8 sd 2msbk mvfr gs 2f-m 0.4 0.6 4 23-41 5YR4/4 c2d5YR5/8 sl 2msbk mvfr gs if-m 0.6 1.0 5 41-62 5YR4/4 C2d5YR5/8 sl m mvfr - if 0.4 0.7 l * Effluent#1=BOD?30<220 mg/1-and TSS>30<150 mg/L 'Effluent#2=BODS<30 mg/L and TSS S_30 mg/- The Department of Safety and Professional Servicese is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,contact the department at 608-266-3151 or TTY through Relay. i Page 3 of 3 Soil Test Site Plan For: Donald and Shirley Rode o Parcel in the NEl/4-SEl/4 Sec. 19 T29N-R17W GeapW 3-,ip—i Town of Hammond-St.Croix County i1wh - eo n P2 Wooded Wind Break Existing Drabs Field Yeast O 2.176 Acres t..lr Existing Concrete Septic Tank I ® Three Bedroom Home Soybean Field � -ta►�#2 shed ' 1v7s P& Bottom of SidingNWHouse Corner=107.31' 'B 84 102.62' IJ B #5 FN#836160th St. mt9r• .%&LL Ant#3 4 _ Top of Well Cadng=104.97' BM P2 Proposed Dose Tank •100.73' Soybean Field 4% B N3 100.50' Note:Property Owned by family farm or out-n ht I purchase ofproperty to be obtained. \ \ 59c 99.so' Elevation Data �_ 98.50' B#1 =96.50' 97.50' A BM=Top of 11/211 Iron Pipe St on Lot Corner B#2 =98.70' Soybean Field * HRP=Same B#3 = 100.08' ASSUMED ELEV._ 100.00 B#4 = 100.82' Backhoe P' B#5 =96.70' ' 6-30-2014 BM#2 =Bottom of Siding N.W. Garage Corner Elev. = 107.31' Keith E. Stoner CST#224059 Parcel #: 018-1043-30-025 08/29/2014 08:06 AM PAGE 1 OF 1 Alt. Parcel#: 19.29.17.301A-10 018-TOWN OF HAMMOND Current 'Xj ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 08/26/2004 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner 0- RODE, DONALD H&SHIRLEY M TR DONALD H&SHIRLEY M TR RODE C-RODE, WARREN A WARREN A RODE 1595 HWY 12 HAMMOND WI 54015 Property Address(es): '=Primary Districts: SC=School SP=Special Type Dist# Description SC 2422 SCH D ST CROIX CENTRAL SP 1700 WITC Notes: Legal Description: Acres: 0.000 SEC 19 T29N R17W(37.83 AC) NE SE EXC S 263.32'OF N 854.83'OF E 360'7&EXC Parcel History: PT TO CSM 18-4821 Date Doc# Vol/Page Type 05/23/2013 979157 TOD 05/09/2006 824860 QC 01/27/2006 817333 WD 03/27/2003 714859 2185/273 ALC more... Plat: '=Primary Tract: (S-T-R 40%160'/4 GL) Block/Condo Bldg: "N/A-NOT AVAILABLE 19-29N-17W 2014 SUMMARY Bill#: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 07/01/2011 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 35.110 7,700 0 7,700 NO UNDEVELOPED G5 0.500 50 0 50 NO Totals for 2014: General Property 35.610 7,750 0 7,750 Woodland 0.000 0 0 Totals for 2013: General Property 35,610 7,750 0 7,750 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 c � a r. 0 fb vl o � 0 0000 o 0) c a 3 OD 0•4 \ A C M Q d 0 N 0 N W N c tD (D 0 O O p n ` W b as BD- 7 fD fD 7 O O O N N N N N N Q ? _ (ND N O PL O O O O O O !D O d -1 O cn A W E 3 O. Q O = � S � i'c 5 .��.. 0 C m cn ZZ D — a ? .�1. m co D w a j � N W Q C N w Ei1 N O A O O O O a r. O O OD -4 N rn a O N N N O ` O O zt W N O co ((�� o m -4 � n r N O o N 3 Q C 000 fT S � ceYl x (A (A � 3 ; a4 o v o Q CD Cr A Q _ �i CD •• O al (D o N N a-AAW U' D D co 0 Q 0 CD CA 7/ Er 4 13 C � V ro Er CL -00 N 1p i'I -' -I CO w p Z CD A Z 0 I � a I O Oo R3 Go Z -1 R3 A _0 M N 8 co CD z A a A X 0 r: fn y 3 m 2 �^ z (p A O =N = D w 3 O n 3 =o 0 X03 3 -^ m c m Z a N V O 0 y 4 cDD 3 al 0 cn N Oq 0 h N S ti M N i N a O (D 0 �. o V C CD C, l `115 - cl-77- `7-3 q ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address g 4 1100 S T Property Address W 11 5 q0 15- (Verification required from Planning&Zoning Department for new construction.) City/State /4 a-,� W Parcel Identification Number O 18 - fo `•13 -- yo - 000 LEGAL DESCRIPTION Property Location N E 1/4 , 5!� 1/4 , Sec. /11 ' T ;Z 4 NR 17 W, Town of 14 . Lot# Subdivision Plat: Certified Survey Map # l o o 1 b SJ ,Volume , Page # QAat Ae4e_dh Zq ffS� (before 2007)Volume , Page # Spec house 0 yes$no Lot lines identifiable kyes 0 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure 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. Owner maintenance responsibilities are specified in§SPS. 383.52(1)and in Chapter 12-St. Croix County Sanitary Ordinance. The property owner agrees to submit to SE Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber,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. Uwe,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein,as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning&Zoning Department within 30 days of the three year expiration date. Uwe 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 property.described above,by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms .� Da?��d ��/ 4 / 14 SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.04/12) CERTIFIED SURVEY MAP LOCATED IN PART OF THE NEl/4 OF THE SE1/4 OF SECTION 19,T29N, RI 7W,TOWN OF HAMMOND,ST. CROIX COUNTY,WISCONSIN DESCRIPTION: A PARCEL OF LAND LOCATED IN THE NORTHEAST QUARTER OF THE SOUTHEAST QUARTER OF SECTION 19,T29N,R17W,TOWN OF HAMMOND,ST.CROIX COUNTY,WISCONSIN,FURTHER DESCRIBED AS FOLLOWS: COMMENCING AT THE EAST QUARTER CORNER OF SAID SECTION 19; THENCE S00'24'57"E 591.51'ALONG THE EAST LINE OF THE SOUTHEAST QUARTER TO THE POINT OF BEGINNING; THENCE CONTINUING ALONG SAID EAST LINE S00°24'57"E 400.36; THENCE S89'12'15"W 362.15'; THENCE N00'26'10"W 400.36'TO A FOUND 1.25"OUTSIDE DIAMETER IRON PIPE; THENCE N89°12,15"E 362.29' TO SAID EAST LINE OF THE SOUTHEAST QUARTER AND THE.POINT OF BEGINNING,CONTAINING 145,016 SQUARE FEET(3.33 ACRES)MORE OR LESS AND BEING SUBJECT TO ANY EASEMENTS,RESTRICTIONS OR COVENANTS OF RECORD. SURVEYOR'S CERnFICATE I,JOSEPH W.GRANBERG,PROFESSIONAL LAND SURVEYOR,HEREBY CERTIFY THAT BY THE DIRECTION OF DONALD&SHIRLEY RODE,OWNERS,1 HAVE SURVEYED AND MAPPED THE LANDS SHOWN HEREON IN ACCORDANCE WITH CHAPTER 236.34 OF THE WISCONSIN STATUTES,THE ST.CROIX COUNTY SUBDIVISION ORDINANCE AND THE TOWN OF HAMMOND SUBDIVISION OR CE AND THAT THIS MAP AND DESCRIPTION ARE A TRUE AND CORRECT REPRESENTATION TO SCALE THEREOF. �J- 2 12 41-1,6mW cc o~$.y JOSE GRANBERG DATE SE<•FI W. G&S D SOLUTIONS,LLC. * RANKM 123 C.T.H."E" 5-2295 NEW RICHMOND,WI 54017 R0 N10ND VA 715-246-7529 I GENERAL NOTICE STATEMENT EACH PARCEL SHOWN ON THIS MAP IS SUBJECT TO STATE,COUNTY AND TOWNSHIP LAWS,RULES AND REGULATIONS(I.E., WETLANDS,MINIMUM LOT SIZE,ACCESS TO PARCEL,ETC.)BEFORE PURCHASING OR DEVELOPING ANY PARCEL CONTACT THE ST.CROIX COUNTY ZONING OFFICE AND THE APPROPRIATE TOWN BOARD FOR ADVICE. EXEMPTION VERIFIED UNDER SECTION 13.1 B.3.a.3)OF THE ST.CROIX COUNTY LAND DIVISION ORDINANCE AND SECTION 236.45(2)(am)(3)OF THE WISCONSIN STATUTES. BY l�I.�kb DATE- F f'_�Di SURVEYOR: PREPARED FOR: LAND As SOLUTIONS JOSEPH GRANBERG DONALD & SHIRLEY RODE DRAFTED BY: JWG 1235 CTY RD. E 836 160TH STREET JOB NO. 100-273 SHEET NEW RICHMOND, WI 54017 HAMMOND. WI 54015 DATE: 10/08/14 2 OF 2 St Croix County 1003165 Page 2 of 2 Vol 26 Page 6052 Adft IMF 1003165 BETH PABST REGISTER OF DEEDS CERTIFIED SURVEY MAP ST. CROIX CO., WI LOCATED IN PART OF THE NEIA OF THE SETA OF SECTION 19,T29N, RECEIVED FOR RECORD RI 7W,TOWN OF HAMMOND,ST.CROIX COUNTY,WISCONSIN 10/21/2014 3:58 PM This Certified Survey Map is for the purposes of adjusting a lot line between a parcel of land described EXEMPT *: In quit claim deed,document number 824859 and the lands to the south of those lands described on REC FEE: 30.00 said quit claim dead. No new lots or paroels have been created by this document The purpose of this COPY FEE: 3.00 Certified Survey Map Is to show the resultant parcel after the new lands have been added. The PAGES: 2 purpose of adjusting the lot line Is to accommodate a new septic system for the subject property. BEARINGS REFERENCED TO THE EAST LINE OF THE SEY4 OF SECTION 19. LINE BEARS SOO°24'57"E ST.CROIX COUNTY COORDINATE SYSTEM. EY4 CORNER,SECTION 19 (SURVEY MARK NAIL FND) =rn N. O 125"IRON PIPE FOUND I Cn I ' S78'08'46'W 2.80' I 66 FROM COMPUTED POSITION N89°12'15"E 362.29' 329.29' 33.00 (R N89-46.00-E 360.00') <I I I 0 IENT LAND DESCRIBED IN 1LI 0) V DOC..NO Q 8246M I `. SHED �?I `W LL I ❑ HOUSE KI W` z ��' cc LOT 7 s ?a N a a ci O 145,018 SQUARE FEET(3-33 AC.) \ o I o C3 Z INCLUDING RIGHT-0F-WAY \ 3 I W 131,804 SQUARE FEET(3-03 AC.) G ^^ I p®�I EXCLUDING RIGHT-OF-WAY i Q `l 1I{UU�U o lr�j N SHED❑Ol a N I ku �i C I CI= O PREVIOUS LOT LINE �-� I I PI LU CD C) I o �.` LAND DESCRIBED IN I QI aD p QUIT CLAIM DEED I DOC.NO.1003122 I Q 329.15' 133.00' S89°12'15"W 362.15' I I it . I LEGEND -INDICATES SECTION CORNER (AS NOTED)® -INDICATES 1.25"OUTSIDE _ ,5C ~ y o DIAMETER IRON PIPE FOUND o ® -INDICATES 0-75"X 18'IRON = N E G ms's RESAR WEIGHING 1.502 Las. t 2295 t PER LINEAR FOOT SET N ICHMOND_ (R) -INDICATES PREVIOUSLY yr) SE CORNER,SECTION 19 RECORDED INFORMATION I f Q` (SURVEY MARK NAIL FND) S UV�yo 2f1 ILI D SCALE IN FEET O' 100' 200' 1" = 100' c f �D SURVEYOR: PREPARED FOR: 5' SOLUTIONS ( JOSEPH GRANBERG DONALD & SHIRLEY RODE DRAFTED BY: JWG 1235 CTY RD. E 836 160TH STREET JOB NO. 100-273 SHEET Q'K:y9; ERG• sol"'V aAr NEW RICHMOND, WI 54017 HAMMOND, WI 54015 DATE: 10/08/14 1 OF 2 Vol 26 Page 6052 St.Croix County 1003165 Page 1 of 2 North, Range Seventeen (17) West, Town of Hammond, St. Croix County, Wisconsin, further described as follows: Commencing at the E '/4 corner of said Section 19; thence S00°24'57"E 854.83' along the east line of the Southeast Quarter of said Section 19 to the southeast corner of those lands described in quit claim deed in document number 824859 in the St. Croix County Register of Deeds, this being the point of beginning (bearings referenced to the east line of the southeast quarter of Section 19, line bears S00 024757"E St. Croix County Coordinate System); thence continuing S00 024'57"E 137.04' along said east line; thence S89°12'15'W 362.15'; thence N00°26'10"W 138.69' to the southwest corner of those lands described in said quit claim deed; thence N89°27'53"E 362.19' along the south line of said lands to the point of beginning, containing 49,930 square feet (1.15 acres) and being subject to any easements, restrictions and covenants of record. (PIN:part of 018-1043-30-025) 3. By this affidavit, we request that the Parcel described in Paragraph 2 be added to the Parcel described in Paragraph 1, so that they shall result in a single parcel for real estate tax purposes. 4. The addition is transfer exempt from Chapter 13 of the St. Croix County Code of Ordinances Land Use and Development pursuant to Section 13.01(B)(3). 5. The purpose of this affidavit is to notify the public of the addition and the resulting parcel. THE DONALD H. RODE AND SHIRLEY M. RODE REVOCABLE LIVING TRUST DATED MARCH 28, 2006 Donald H. Rode,trustee Warren A. Rode 42 ° Shirley M. Jf6de, trustee Diane L. Rode Subscribed and sworn to before me the above-named Donald H. Rode and Shirley M.Rode as trustees of the Donald M. Rode and Shirley M. Rode Revocable Living trust dated MW%gh aA1 2006 and Warren A. Rode and Diane L. Rode, husband and wife, n this 161 day of October,2014. ``�`�P•N E BOet'."", G ` OT g9 Leah E. Boeve I "_ Notary Public,State of Wisconsin My Commission is Permanent. %NJ�' A \G Z This document is exempt from return and fee pur nDpo�{gS- a�. s. 77.21(() and s. 77.22(1) as it is not a conveyance of ownership interest. ���i�liiui"'��� THIS DOCUMENT DRAFTED BY: Leah E.Boeve, 1081407 REIIINGTON LAW OFFICES,LLC 126 S.Knowles Avenue New Richmond,WI 54017 St.Croix County 1003123 Page 2 of 2 �1. , II IIIIIIIIIIIIIIIIIIIIIIIII I III 8263808 Tx:4215589 1003123 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 10/20/2014 4:00 PM EXEMPT #: AFFIDAVIT REC FEE: 30.00 PAGES: 2 II STATE OF WISCONSIN ) REMINGTON LAW OFFICES,LLC ss. .126 S. Knowles Ave. ST. CROIX COUNTY ) New Richmond, WI 54017 PIN:0 18-1043-40-000& part of 018-1043-30-025 We, Donald H. Rode and Shirley M. Rode, as trustees of the Donald H. Rode and Shirley M. Rode Revocable Living Trust dated March 28, 2006, and Warren A. Rode and Diane L. Rode, husband and wife, being duly sworn, state,under oath that: 1. The Donald H. Rode and Shirley M. Rode Revocable Living Trust dated March 28, 2006 is the owner of the following parcel of land located in St. Croix County, Wisconsin, recorded on May 9, 2006 in the St. Croix County Register of Deed's Office, including exceptions of record since property was acquired now described as follows: A parcel of land located in the Northeast Quarter of the Southeast Quarter (NE '/4 of SE '/4) of Section Nineteen (19), Township Twenty-nine (29) North, Range Seventeen (17) West, Town of Hammond, being further described as follows: Commencing.at the East '/4 corner of said Section i 19; thence South along the East line of said Section 591.51 feet to the point of beginning; thence continuing South along said East line 263.32 feet; thence South 89° 46'00" West 360.00 feet; thence North 263.32 feet; thence North 89° 46'00"East 360.00 feet to the point of beginning. (PIN: 018-1043-40-000) 2. The Donald H. Rode and Shirley M. Rode Revocable Living Trust dated March 28, 2006 and Warren A. Rode and Diane L. Rode, husband and wife, are the owners of the following parcel of land located in St. Croix County, Wisconsin, recorded on April 2, 1980 and May 9, 2006 in the St. Croix County Register of Deed's Office, including exceptions of record since property was acquired now described as follows: A parcel of land located in the Northeast Quarter of the Southeast Quarter (NE '/4 of SE '/4) of Section Nineteen (19), Township Twenty-nine (29) St. Croix County 1003123 Page 1 of 2 4l 824659 STATE BAR OF WISCONSIN FORM 3-1999 KATHLEEN H. NALSH Document Number QUIT CLAIM DEED REGISTER OF DEEDS ST. CROIX CO., 'MI This Deed,made between Donald H.Rode and Shirley M.Rode, RECEIVED FOR RECORD husband and wife, 05/09/2006 10:30AN QUIT CLAIK DEED Grantor, and Donald H.Rode and Shirley M.Rode as trustees and Exxf # is. successor trustees of the Donald H.Rode and Shirley M.Rode REC FEE: 11.00 Revocable Living Trust dated March 28,2006, TRANS FEE: COPY FEE: CC FEE: Grantee. PAGES. 1 Grantor quit claims to Grantee the following described real estate in St.Croix County,State of Wisconsin(if more space is needed,please attach addendum): Recording Area A parcel of land located in the Northeast Quarter of the Southeast Quarter(NE1/4 of Name and Return Address SEl/4)of Section Nineteen(19),Township Twenty-nine(29)North,Range Seventeen(17)West,Town of Hammond,being further described as follows: Judith A.Remington Commencing at the East l/4 corner of said Section 19;thence South along the East Remington Law Offices line of said Section 591.51 feet to the point of beginning;thence continuing South P.O.Box 177 along said East line 263.32 feet;thence South 89°46'00"West 360.00 feet;thence New Richmond WI 54017 North 263.32 feet;thence North 89°46'00"East 360.00 feet to the point of ' beginning. 018-104340-000 Parcel Identification Number(PIN) This is homestead property. (is) (iat) Together with all appurtenant rights,title and interests. Dated this j"'!% day of May 2006 * * DONALD H.RODE * *SHIRLE M RODE AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) )ss. ST.CROIX County ) authenticated this day of Personally came before me this �day of May , 2006 the above named * Donald H.Rode and Shirley M.Rode,husband and wife, TITLE:MEMBER STATE BAR OF WISCONSIN to me known to be the person(s)who executed the foregoing (If not, instrument and acknowledged the same. authorized by § 706.06,Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY * TAffith A.Remington Judith A.Remington#1016706,Remington Law Offices,LLC Notary Public,State of Wisconsin P.O.Box 177,New Richmond,WI 54017(715)246-3422 My Commission is permanent.(if not,state expiration date: (Signatures may be authenticated or acknowledged.Both are not necessary.) •) *Names of persons signing in any capacity must be typed or printed below their signature. tnformanon Professionals company,Fond du Lac,wi STATE BAR OF WISCONSIN aOD-655-2021 QUIT CLAIM DEED FORM No.3-1999 1 of 1