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030-2061-90-000 (4)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 572821 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: Mondor, Scott M. St. Joseph, Town of 030-2061-90-000 CST BM Elev: Insp.BM Elev: Desgription: Section/Town/Range/Map No: BM c1- y 2 � y. Y2- f 1 4M 2 27.30.20.594 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic j j �� � `19� J Benchmar�� - Z o• Dosing S-z Alt.BM Aeration ' Bldg.Sewer L1 ��- 7-51 S e4n Holding SUHt Inlet 7 �//�3 St/Ht Outlet �- TANK SETBACK INFORMATION TANK TO /P/L� WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic i r N + Dt Bottom q 9 q/ Dosing � I vkk Header/Man. Aeration Dist. Pipe Holding Bot.System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cove GPM Model Number 3 yvlro1 TDH Lift Friction Loss System Head TDH Ft I tin Forcemain Length Dia. Dist,to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipes) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil (/0 Yes L] No Yes No COMMENTS: (Include code discrepancies,persons present,etc.) Inspection#1: -/ / 7 Inspection#2: Location: 53 Church Street Houlton,,WI 54082(SW 1/4/NEp,1/4 27 T30N R20W) Village of Hou ton Lot 1 di Parcel No: 27.30.20.594 1.)Alt BM Description=-PUwtr C cwt � 1���^� 2.)Bldg sewer length= �0+ - j('t j -amount of cover= Plan revision Required? Yes [I No Use other side for additional information. Cart.No. Date Insepctor's Signature SBD-6710(R.3/97) PLOT PLAN N j Project Name: Mondor 3 Bedroom Mound Legal Description: SW1/4,NE114,S27,T30N,R20W P.I.D-. 030-2061-90-000 Subdivision Name: Plat of Houlton Lot#: 1 SCALE:V=30' Township: ST.JOSEPH Parcel Size: 0.72 Acres County: ST.CROIX Contour Line Elevation: 99.28' Cell Dimensions: 6'X 75' 4 inch Sch 40-ASTM D2665 System Elevation 102.33' Mound Dimensions: 91.29'x 20.85' 2 inch Sch 40-ASTM D1785 SIoDe: 3% 11/2 Sch 40-ASTM D1785 A BM1 Elevation: 1100.00' jTop of Well A BM2 Elevation: [99.42' Bottom of siding ■ Backhoe Pits: - � l I j-1 C A5 E tvi.2. VV E L L. O 0 V9 �0 L�� Z.S- C. CAN i d�lR L �J t; ~ 3 Page 11 County Safety and Buildings Division %. C A?0/ k 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) P� J Madison,WI 53707-7162 RECEIVED 15 7ZS State Transaction Number Sanitary Permit Application p 4 Z q 7 8O In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the a Triato mmental it is required prior to obtaining a sanitary permit. Note:Application forms for state- ed to Project Address(if different than mailing address) the Department of Safety and Professional Servies. Personal information you� j �v purposes in accordance with the Privacy Law,s.15.04 1 m,Stats. UUU r N C / I. Application Information-Please Print All In ation l Property Owner's Name Parcel# 5c0 1 AA 0W no 0- (930 - 04P/-- 0-000 Property Owner's Mailing Address Property Location 2 O D / pT N r t Govt.Lot (/ City,State Zip Code Phone Number 15*VU y,, /%J E y4, Section Z 7 S )4 r e-I e- Is'-/'o rcle one L—(O T�O N; R r?� E or�' II.Type of Building(check all that apply) Lot# (�I or 2 Family Dwelling-Number of Bedroo ` Subdivision Name AS o ` Block q PL 14'T e,1, 140 Lie I F]Public/Commercial-Describe Use ❑ City of CSM Number El Village of 7- ❑State Owned-Describe Use I / N Town of 3^/ o✓n III.Type of Permit: (Check only one box on line A. Complete line B if applicable) A. Q.New System ❑ Replacement System ❑Treatment/Holding Tank Replacement Only El Other Modification to Existing System(explain) B. ❑ Permit Renewal ❑ Permit Revision ❑Change of Plumber List Previoy� rte/ umber and Date sue� ❑Permit Transfer to New �� ''flff /Z/5/40 � / Before Expiration Owner IV.Type of POWTS System/Component/Device: Check all that apply) D/L C�J ❑Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑At-Grade JK Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil ❑ Holding Tank ❑Other Dispersal Component(explain) ❑P treatment Device(explain) i V.Dispersal/Treatinent Area Information: Design Flow(gpd) Design Soil Application Rate( dsf) Dispersal Area Required(so Dispersal Area Proposed System Elevation / qyo VI.Tank Info Capacity in Total #of Manufacturer B Gallons Gallons Units /� o U y y New Tanks Existing Tanks 1/ I /r "a�i o ,44 u in ti cn C7 P, Septic or Holding Tank /000 / / Cc,v���P� '� Dosing Chamber VII.Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's afore MP/MPRS Number Business Phone Number J ©H N sc H tn rr ���� ZZ3 7� 0 7"s �6 D-O �/8 Plumber's Address(Street,City,State,Zip Code) 6/6 /J`-®%%1 4 v4-= V11"ounty/De artment Use Only Permit Fee Date I sued Issuing ent Signatur pproved ❑❑ eason for Denial $ �15 . O a /b / IX.Cond%fgT0AV*R4F"easons for Disapproval 3� Go�.� 1. septic'tank,effluent fitter and dispersal cell must all be serbtc�jt'rriaitltainAe e t cs W as per management plan provided by plumber. \ 2. A#setback requirements must be.miirltaitl2d J Q 0 (,�;A- *U 0 e�- as per gvka*code'7 ord nanlm. Attach to complete plans for the system and submit to the County only on paper not less than 81/2 x 11 inches in size SBD-6398(R. 11/11) JOHN F SCHMITT Page 2 10/13/2014 r • SPS 383.22(7)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 Owner Responsibilities: • SPS 383.52 Responsibilities. 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). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4)shall be considered a human health hazard. • SPS 383.55 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. 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. When You Receive That Invoice, Charles L Bratz Please Include a Copy With Your POWTS Reviewer 2,Integrated Services Payment Submittal. (608)789-7893 ,7:45 am-4:30 pm Monday-Friday WiSMART code:7633 charles.bratz@wisconsin.gov cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm i I I �ptiY�T+4EnT DIVISION OF INDUSTRY SERVICES 3824 N CREEKSIDE LA HOLMEN WI 54636 Contact Through Relay P http://dsps.wi.gov/programs/industry-services www.wisconsin.gov siort�ti5� Scott Walker,Governor Dave Ross,Secretary October 13,2014 CUST ID No. 223760 ATTIC•POWTS Inspector JOHN F SCHMITT ZONING OFFICE SCHMITT&SONS EXCAVATING ST CROIX COUNTY SPIA 616 150TH AVE 1101 CARMICHAEL RD SOMERSET WI 54025 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/13/2016 Identification Numbers Transaction ID No.2467080 SITE: Site ID No. 807108 Mondor Please refer to both identification numbers, 53 Church St above,in all correspondence with the agency. Town of Saint Joseph St Croix County SWIA,NEIA, S27,T30N,R20W Lot: 1,Block: 9,Subdivision:Plat of Houlton FOR: Description:Mound/Three Bedroom/Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1508210 Maintenance required; 450 GPD Flow rate; 26 in Soil minimum depth to limiting factor from original grade; System: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. The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code requirements. 01.E No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, GON p stats. Pp The following conditions shall be met during construction or installation and prior to occupancy or use: 'D O�s $ Reminders PRON OF 1 • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. >See • Per manual cited above,limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction,excavation,vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank,and a minimum of 50 feet from the absorption area.chs.NR 811 &812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19,Wis.Stats. • Inspection of the POWTS 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.Stat JOHN F SCHIV= Page 2 10/13/2014 • SPS 383.22(7)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. Owner Responsibilities: • SPS 383.52 Responsibilities. 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). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s.SPS 383.54(4)shall be considered a human health hazard. • SPS 383.55 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. 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. (� When You Receive That Invoice, Charles L Bratz Please Include a Copy With Your POWTS Reviewer 2,Integrated Services Payment Submittal. (608)789-7893 ,7:45 am-4:30 pm Monday-Friday WiSMART code:7633 charles.bratz @wisconsin.gov cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm b MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PA GE RECEIVED OCT S 2014 Project Name: Mondor 3 Bedroom Mound as;r� , i�Y SERVICE:; Owners Name: Scott Mondor Owner's Address 2040 10th Ave. Star Prairie, WI 54026 Legal Description: SW1/4, NE1/4, S27, T30N, R20W Township St. Joseph County: St. Croix Subdivision Name: Plat of Houlton Lot Number: 1 Block Number 9 Parcel I.D. Number 030-2061-90-000 Plan Transaction No. Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Septic and Dose tank specifications Page 8 Effluent filter information ONALLY Page 9 & 10 Pump specifications and curve OVED Page 11 Plot plan FETY AND Page 12 Septic tank maintenance agreement �A SERVICES Page 13 Warranty deed ►NAL Page 14 CSM IDUSTRY SERVICES Attachment Soil evaluation report Designer: John Schmitt License Number: 223760 Date: 9/22/2014 Phone Number: 715-760 Ft, Signature: �ORR Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P(N.01/01)and both SSWMP Publication 9.6 Design of pressure Distribution Networks for ST-SAS(10/81)and Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N.01/01) Version 7.0 (R. 03/2012) Page 1 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) RI 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 fecal coliform of<=36 inches. 1.501, Peaking Factor(e.g. 1.5= 150%) 450.00 Design Flow(gpd) 3.00' Site Slope(%) 99.28; Contour Line Elevation (ft) 26.001 Depth to Limiting Factor(in) 0.40 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 75.001, Dispersal Cell Length Along Contour(ft) = F 6.00 Cell Width (ft) 1.00; Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality(1 or 2) Are the laterals the highest point in the distribution Y Press_ure Disribution Information network? Enter Y or N (C or E) w C Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft _ 4: Number of Laterals of the highest point. _ 0.188 Orifice Diameter(in) 2.501 Estimated Orifice Spacing (ft) = 7.50 ft2/orifice 2.00! Forcemain Diameter(in) __0Forcemain Length (ft) Does the forcemain drain back? Y 91.00; Pump Tank Elevation (ft) Enter Y or N 3.25 System Head (ft)x 1.3 12.23 Forcemain Drainback (gal) 8.70 Vertical Lift(ft) 67.32 5x Void Volume (gal) 2.40 Friction Loss(ft) 79.55 Minimum Dose Volume (gal) 0.00: In-line Filter Loss(ft) 39.32 System Demand (gpm) 14.34 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia_ o tions choice in. dia. options choice 0.75 � 1.25 1.00 _..__._. 1.50 x x 1.25 x __.. _-- 2.00 x 1.50 x _ x_.__. 3.00 2.00 x ,. 3.00 x Gallons/Inch Calculator(optional) Treatment Tank Information _ ~? Total Tank Capacity(gal) 1000.0_0 Septic Tank Capacity(gal) Total Working Liquid Depth (in) i Wieser Concrete Manufacturer gal/in (enter result in cell 649) Dose Tank Information Effluent Filter Information 650.001 Dose Tank Capacity(gal) Plok� Filter Manufacturer _ 17.00; Dose Tank Volume (gal/in) :525 v _ Filter Model Number Wieser Concrete Manufacturer Project: Mondor 53 Church Street Page 2 I Mound Plan and Cross Section Views T :.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.: •.•.:.:.:.:.:.: : : : : : : : : ::::;::.. . . . J 1/10 B : : : : : : : : : : : : . . . . . .• Observation Pipe ' . _ 1 T K: : . . fl A W : : ► . . . . : . . . : : : : : : : . . .: : B . . " r ............................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . L Mound Component Dimensions Down slope toe extension made. A 6.00 ft E 12.161 in H 1.00ft K 8.15ft B 75.00 ft F 9.50 in z 9.00 ft L 91.29 ft D 10.00 in G 0.50 ft J 5.85 ft W 20.85 ft 450.00 (ft) Dispersal Cell Area F 1125.00 (ft) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.91 (ft) --► Gj I F : . . Dispersal Cell 100.61 ( I (ft) Lateral 100.11 (ft)—► — Invert Dispersal Cell ; ] Elevation D 4 � 99.28 (ft) Contour Elevation 3.0 % Site Slope Geotextile Fabric Cover Shading Key -0 e_ T Dispersal Cell See lateral details on 10 Topsoil Cap 0 ° 1.5 ft Page 4 for number,size, Subsoil Cap h ® and spacing of laterals. ASTM C33 Sand i° ea F Laterals are equally spaced from the Typical Lateral Tilled Layer � � 0.5 ft distribution cell's © Aggregate v c � .: centerline in the 1. A # distribution cell(AxB). Project: Mondor 53 Church Street Page 3 Center Connection Lateral Layout Diagram Force main connection via tee or cross to manifold at any point. Laterals are identic al P s S •=Turn-up vWball valve or IFX--j�Ex12�' A+241 Laterals&forcemain Sch 40 PVC cleanoutplug per SPS Table 384.30-6 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.188 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 36.69 ft Orifices per Lateral 15 Lateral Spacing (S) 3.00 ft Orifice Density 7.50 ft2/orifice Lateral Flow Rate 9.83 gpm Manifold Length 3.00 ft System Flow Rate 39.32 gpm Manifold Diameter 1.50 in Total Dynamic Head 14.34 ft Forcemain Velocity 4.02 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and —% 1� SPS 316.300 WAC 4 in.min. Disconnect ---�_ Tank component is properly vented : F— Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Capacityl 650.00 Gallons —T Volume 17.00 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 20.56 349.45 ID B 2.00 34.00 P� ump off elevation(ft) C _4.68 79.55 91.92 D _11.00': 187.00 Total 3872-4--r- 8.24 650.00 Dose tank elevation(ft) 3" Bedding uncler tank. 91.00 Alarm Manuafacturer ;_§jif Rhombus Note: Switches Alarm Model Number 'AB containing mercury may not be used in Pump Manufacturer Zoeller y this system. Pump Model Number 152 Pump Must Deliver 39.32 gpm at 14.34 ft TDH Project: Mondor 53 Church Street Page 4 I Mound System Maintenance and Operation Specifications Service Providers Name John Schmitt Phone: 715-760-0486 POWTS Regulator's Name 77 St Croix County Zoning_ _ Phone; 715-386-46 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 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency 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 month) Pressure System Laterals should be flushed and pressure tested every 3 years Mound Inspect forpondinq and seepage once eve 3 years 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 ............... Grade 6-8" Diameter Lawn — Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution _y► Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Mondor 53 Church Street Page 5 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,R. 10/12),SSWMP Publication 9.6(01/81),and Pressure Distribution Component Manual Ver.2.0 SBD- 10706-P(N.01/01,R.10/12))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 fitter shall be assessed at least once every 3 years by inspection. The outlet fitter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed w unless an alarm,the are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped filter shall be serviced if the alarm is activated continuously. Intermittent filter 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 e 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 BODY,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 re commended 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. Continaency 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 I 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 L a6ed D Ai 54j" AS 84 D REQD m m 43 r z D n m v , UP 42" � n 4" CAS D 1 3" 461" 5„ D D m 1 m cl) m m 0 — 38" rD- m 0 S CA n UP 40" N J � 4" CAS D C co, m ` m o I z c i r. N 0 o A t D 41" � D o m N D i rn m 590 r- S2 D r C zrs+1 z z y '� m m m D N z �W� z n > mrow*g i Z c � 0F� m Z o 0 o OK XX > 9z 0:*.. U)v) =1 a) m m00 mDO --1 -4 �n \r O cm Nm\ m a o �Nc INc O° m om - -i F � ? ' m w-.4 50 ::1 u) n19 p m om (n DN -I 00�\� D � V TI 0) 5g A p Cm O CNm = Cs D r a O N N cn v m O m zz v m o z D O D mo �a m n o i O C� rD p m n n D n m I O Z Z ZZ v � N� �D m z� m I z C 0 r.'0 M O C p m O N .i r � n A A � O A m F c r�* H g m O Z r rn \ V) XP1000/650-MR DRAWN BY: SME SCALE: 1/4"=V-0" PRE-POUR: O m MIERERCODCAETE POST-POUR: SEPTIC MANUAL W3716 US HWY 10 MAIDEN ROCK, WI 54750 DATE: JANUARY 2010 DATE:. \P REVISED JAN. 2010 800-325-8456 FILE: "000/650-MR Pte. ._ '" �'"` PL-525 Effluent Filter dnmvauo"s in P.epst Drainage 7abelt &Wastewater ProdrO A OVISM a Poly"hr- PL-525 Filter The PL-525 Filter is rated for 10,000 GPD(gallons per day)making it one of the largest filters in its class.It has 325 linear feet of 1/16" filtration slots.Like the Polylok PL-122,the Polylok PL-525 has an automatic shut-off ball installed with every filter.When the filter is removed for cleaning,the ball will float up and temporarily shut off the system so the effluent won't leave the tank- Features: 1/16„ Filtration Slots Alarm Switch • Rated for 10,000 GPD(gallons per day). El 0 QQQ GPD l��l • 525 linear feet of 1/16”filtration r -<Z=====3 Accepts 1"PVC • Accepts 4"and 6"SCHD 40 pipe. Extension Handle • Built in gas deflector. • Automatic shut-off ball when filter is removed. Rated for • Alarm accessibility. 10AW GPD • Accepts PVC extension handle. PL-525 Installation: 525 Linear Ft. Ideal for residential and commercial waste flows up to of 1/16" 10,000 gallons per day(GPD). Filtration Slots 1.Locate the outlet of the septic tank. 2.Remove the tank cover and pump tank if necessary. Accepts 4-&e 3.Glue the filter housing to the 4"or 6"outlet pipe.)f SCHD 40 pipe the filter is not centered under the access opening use a Polylok Extend&Lok or piece of pipe to center filter. 4.Insert the PL-525 filter into its housing. Coed to 5.Replace and secure the septic tank cover. NSFIANN Stmullwd 46 PL-525 Maintenance: ' The PL-525 Effluent Filters will operate efficiently for several years under normal conditions before requiring � ro cleaning.It is recommended that the filter be cleaned every time the tank is pumped,or at least every three years.If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter Gas Deflection needs servicing.Servicing should be done by a certified septic tank pumper or installer. Automats Shut-Off Ball 1.Locate the outlet of the septic tank. 2 Remove tank cover and pump tank if necessary. 3.Do not use plumbing when filter is removed. 4.Pull PL-525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. 6.Insert the filter cartridge back into the housing making Outdoor SmartFilterR�Alarm Extend&Lok7M sure the filter is properly allgred and completely inserted. Polylok Zabel&Best filters accept wily installs 7.Replace and secure septic tank cover. the SmartFilter®switch and alarm. into existing tanks. Polylok,Inc. 3 Fairfield Blvd. Wallingford,CT 06492 Toll Free:877.765.9565 Fax 203.284.8514 www.polylok.com Page 8 SECTION: 2.20.047 `Q&AllTV 0,UM599 FlAME I91i.7 N .` FM1919 0110 � O supersedes Product information presented �• here reflects conditions at time /7Z1") L 7- of publication.Consult factory u regarding discrepancies or visit our web site: inconsistencies. MAIL TO: P.O.BOX 16347•Louisville,KY 40256-0347 SHIP TO: 3649 Cane Run Road •Louisville,KY 40211-1961 www.zooller.com (502)778-2731.1(800)928-PUMP•FAX(502)774-3624 COMPARE THESE FEATURES • Durable cast iron construction 151/152/153 EFFLUENT SERIES • Model 151 comes standard with a glass-filled polypropylene base (For Pump Prefix Identification see News& Views 0052) • Corrosion resistant powder coated epoxy finish 16 • Stainless steel lifting handle DOSE =MATE " • Assembled with stainless steel bolts FOR SEPTIC TANK- LOW PRESSURE PIPE(LPP) • Non-clogging engineered thermoplastic vortex AND ENHANCED FLOW STEP SYSTEMS impeller design • Model 151 -1/3 HP passes W spherical solids EFFLUENT • Model 152-.4 HP passes%"spherical solids SUBMERSIBLE • Model 153-1/2 HP passes Y/4"spherical solids 1'/s" NPT DISCHARGE • Motor-60 Hz,3450 RPM,oil-filled, hermetically sealed,automatic reset thermal overload protected Model N152/N153 • Carbon/Ceramic seals High Head C cau-s Effluent • Upper sleeve bearing and lower ball bearing running T«adroULStd■dUL778 and CWWW m csA in bath of oil SWdwd csn22.2 w.108 • 20 ft. UL Listed power cord with molded 3-wire plug • 1 W NPT vertical discharge MODELS AVAILABLE • BN and BE standard models include a 20 ft.variable N151/N152/N153&E151052053 nonautomatic level float switch BN1511BN152/BN153&BE151/BE152/BE153 packaged with Piggyback Variable Level Float switch • Operates at temperatures to 130°F(54°C)in effluent .1/3,.4&1/2 HP,1Ph 115V or 230V applications • All models include a 1%"x 2" PVC adapter fitting Note:The sizing of effluent systems normally requires variable level float(s)controls and properly sized basins to achieve required pumping cycles or dosing timers with nonautomatic pumps, POWDER COATED i TOUGH' U161Mf L 7 Model BN15VBN153 High Head MAIL TO: P.O. BOX 16347 Effluent Louisville,KY 40256-0347 SHIP T0: 3649 Cane Run Road Louisville,KY 40211-1961 (502)778-2731.1(800)928-PUMP FAX(502)774-3624 Manufacturers of... Z `QL64L/r.-19UMP6 sNCE IF,/,.! " ®Copyright 2010 Zoeller Co.All rights reserved. Page 9 TOTAL DYNAMIC HEAD/FLOW g LL PUMP PERFORMANCE CURVE PER MINUTE MODEL 1511152/153 EFFLUENT AND DEWATERING 50 14- as 1$3 153 MODEL 151 152 12 40 Feet Meters Gal. Liters Gal. Liters Gal. Liters 5 1.5 50 189 69 261 77 291 35 152 10 3.0 45 170 61 231 70 265 10 30 15 4.6 38 144 53 201 61 231 20 6.1 29 110 44 167 52 197 '0 8- 26 151 25 7.6 16 61 34 129 42 159 30 9.1 – – 23 87 33 125 ° 6 20 _ – 22 85 35 10.7 40 12.2 – – – – 11 42 4 Shut-off Head: 30 R.(9.1 m) 38 R.(t+.6m) 44 R.(13.4m 0145089 10 2 5 Model 151 Models 152 1 153 a 10 20 30 40 50 fi0 70 80 90 +00 67132----1 GALLONS 67132 LITERS y _ 1 3716 45A 0 a0 80 120 1 0 200 240 2 320 360 3 718 – f 4 516 FLOW PER MINUTE I� i 014508A _— _ 3718 CONSULT FACTORY FOR 37M SPECIAL APPLICATIONS 3718 •Timed dosing panels available -- —t--� 1 1 Z NPr •Electrical alternators,for duplex systems,are available and supplied with an alarm i •Variable level control switches are available for controlling ---- — --- single phase systems •Double piggyback variable level float switches are available for variable level long and short cycle controls re j •Sealed Qwik-Box available for outdoor installations-See +111116 21, FM1420 •Over 130°F(54°C)special quotation required 415116 538 _L I 15111521153 Series —_— SK2444 SK2054 15111521153 MODELS Control Selection Model Volts-ph Mode Amps Simplex Duplex N151 115 1 Non 6.0 1 2 or 3 BN151 115 1 Auto 6.0 Included 2 or 3 HE 230 1 Non 3.2 1 --Tor 3 BE151 230 1 Auto 3.2 Included 2 or 3 "Easy assembly" N152 115 1 Non 8.5 1 2 or 3 (pump&discharge pipe BN152 115 1 Auto 6.5 Included 2 or 3 not included.) _E1152- 30 1 Non 4. 1 2 or 3 152 230 Auto 4. Included 2 or 3 N7 115 1 Non 10.5 2 or 3 BN153 115 1 Auto 10.5 Included 2 or 3 E153 230 1 1 Non 5.3 1 2 or 3 BE153 230 1 Auto 5.3 Ir cluded 2 or 3 SELECTION GUIDE OPTIONAL PUMP STAND PIN 10.2421 1. Single piggyback variable level float switch or double piggyback variable level Reduces potential clogging by debris float switch. Refer to FM0477. • Replaces rocks or bricks under the pump 2. See FM0712 for correct model of Electrical Alternator E-Pak. Made of durable,noncorrosive ABS 3. Variable level control switch 10-0743 used as a control activator,specify duplex Raises pump 2"off bottom of basin (3)or(4)float system. • Provides the ability to raise intake by adding sections of 1 W or 2"PVC piping O CAUTION Attaches securely to pump All installation of controls,protection devices and wiring should be done by a qualified • Accommodates sump,dewatering and effluent applications licensed electrician. All electrical and safety codes should be followed including the NOTE:Make sure float is free from obstruction. most recent National Electrical Code(NEC)and the Occupational Safety and Health Act(OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. ©Copyright 2010 Zoeller Co.All rights reserved. Page 10 , PLOT PLAN N Project Name: Mondor 3 Bedroom Mound Legal Description: SW1 14,NE1 14,S27,T30N,R20W P.I.D: 030-2061-90-000 Subdivision Name: Plat of Houlton Lot#: 1 SCALE:1..-30' Township: ST.JOSEPH Parcel Size: 0.72 Acres County: ST.CROIX Contour Line Elevation: 99.28' Cell Dimensions: 6'X 75' 4 inch Sch 40-ASTM D2665 System Elevation 102.33 Mound Dimensions: 91.29'x 20.85' 2 inch Sch 40-ASTM D1785 Slope: 3% 1112 Sch 40-ASTM D1785 A BM1 Elevation: ,100.00' JTop of Well A BM2 Elevation: 99.42' Bottom of siding ■ Backhoe Pits: e H w t2C"ri s" Q(SiVFU�I'rJ c)(A E s�111 z D _ VA"r LL- 0 0 t7OU16 50 5.T 0 Lr 83 _ Page 11 F ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Scott Mondor Mailing Address 2040 10th Ave , Star Prairie, WI 54026 Property Address 53 Church Street (Verification required from Planning&Zoning Department for new construction.) City/State Houlton, WI Parcel Identification Number 030-2061 -90-000 LEGAL DESCRIPTION Property Location SW 1/4 , NE 1/4 , Sec. 27 , T 30 N R 20 W, Town of St. Joseph Subdivision Plat.Plat of Hou lton , Lot# 1 Certified Survey Map# , Volume , Page# Warranty Deed # (before 2007)Volume , Page# Spec house 13yesElno Lot lines identifiable Dyes[]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 St.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. I/we,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. I/we certify that all statements on this fo 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 warrant deed recorded in Register of Deeds Office. Number of bedrooms 3 /jt"� 1 /1-1/ A/ IGNATURE 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) I State Bar of Wisconsin Form 3-2003 111111111111111111111111111 QUIT CLAIM DEED 8 0 4 2 8 8 5 Tx:4030965 Document Number Document Name 946067 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED,made between Mary Mondor 11/21/2011 4.30 PM I s` EXEMPT#: 8M REC FEE: 30.00 ± ("Grantor,"whether one or more),and Scott M.Mondor COPY FEE: 2.00 t PAG ES: 1 , r s ("Grantee,"whether one or more). Grantor quit claims to Grantee the following described real estate,together with the rents,profits,fixtures and other appurtenant interests,in St.Croix Recording Area C County,State of Wisconsin("Property")(if more space is needed,please attach addendum): Name and Return Address ' Lot One(1),Block Nine(9)in Section Twenty-seven(27),Township Thirty(30) Heywood,Carl&Anderson,S.C. North,Range Twenty(20)West,being in the Village of Houlton,according to Chris Anderson recorded Plat. 816 Dominion Drive.P.O.Box 125 t Hudson,WI 54016 d k 030-2061-90-000 Parcel Identification Number(PIN) This is not homestead property. (is not) t j This deed is being given pursuant to a judgment of divorce in Polk County Case Number 08 FA 117. f j Dated February 11,2011 a 3` (SEAL) (SEAL) €; * Mary Mondor * ' s (SEAL) (SEAL) 3 AUTHENTICATION ACKNOWLEDGMENT Signature(s) Mary Mondor STATE OF ) s ss. i authentica ed on February 11,2011 COUNTY) Personally came before me on x *Christopher M.Anderson,WI Bar 1041095 the above-named TITLE:MEMBER STATE BAR OF WISCONSIN j (If not, to me known to be the person(s) who executed the foregoing n authorized by Wis.Stat. §706.06) instrument and acknowledged the same. r "s THIS INSTR MENT DRAFTED Y: Notary Public,State of My commission(is permanent)(expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. QUIT CLAIM DEED (02003 STATE BAR OF WISCONSIN FORM NO.3-2003 *Type name below signatures. INFO-PRO'Legal Forms-(800)655-2021•infoproforms.com r 1 of 1 Y k I �aaXlTNtw s Department of SOIL EVALUATION REPORT #1723 i Safety and in accordance with Comm 85,Wis,Adm.Code Page 1 of 3 _ Professional Services Schmitt Soil Testing,Inc. County Attach complete site plan on paper not less than 8%x 11 inches in size. Plan must St.Croix include,but not limited to:vertical and horizontal reference point(BM),direction and percent slope,scale or dimensions,north ar nd location and distance to neareslroad. I.D. (J 0-2061-90-000 Please pri a adon. � evie Date Personal information you provide or ary purposes(Privacy Law,s.15.Uo)(m)). ,� �{ ' 23 Property Owner Property Lo Mondor,Scott M. Govt.Lot ±� G SW1/4, NE1/4, S27,T30N, R20W Property Owner's Mailing Address Lot# Block# $ubd.Name or CSM# 2040 10th Ave. 1 1 9 PLAT OF HOULTON City State Zip Code Phone Number City E Village Z Town Nearest Road Star WI 715-248-7702 St.Joseph Church St. New Construction U Z Residential/ umber of bedrooms 3 Code derived design flow rate 450 GPD lace r commercial-Describe: Parent material Glacial ill Otterholt Series) Flood plain elevation,if applicable NA ft. General comments Area is suitable for a mound system. Sys m elevation is 100.12'Based off acontour line established at 99.28'. Slope of area is and recommendations: 3%. Depth to limiting factor is 26". '�, j , , 7� ?•� 1 Boring# Boring Pit Ground surface elev. 98.68 ft. Depth to limiting factor 28 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 -Eff#2 1 0-8 10yr4/4 none vfsl 2msbk mvfr Cs 2m,1f 0.4 0.8 2 8-28 10yr5/3 none Ivfs lcsbk mvfr gW 2m,lf 0.4 0.6 3 28-33 10yr4/4 c2d 10yr6/3 Ivfs lcsbk mfr gW if 0.4 0.6 10yr5/8 4 33-63 7.5yr4/6 c2d 10yr6/1 vfsl Om mfi a ------ 0.2 0.5 10yr6/8 5 63-84 7.S r5/6 m2d 10yr6/2 VN Om mf ---- ------ 0.2 0.5 y 10yr6/8 2 Boring# Boring Z Pit Ground surface elev. 99.38 ft. Depth to limiting factor 26 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. I -Eff#1 'Eff#2 1 0-4 10yr4/3 none vfsi 2msbk mfr gW 2m,1f 0.4 0.8 2 4-26 10yr5/3 none Ivfs lcsbk mfr gW lvf 0.4 0.6 3 26-38 7.5yr4/6 c2 1 0r6/8 yr6/8 3 vfsl lcsbk mfr g v ------ 0.2 0.6 4 38-72 7.5yr5/6 m2d 10yr6/2 sil Om mfi ---- ------ 0.0 0.2 10yr6/8 *Effluent#1=BODS>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BODS<30 mg/L and TSS<_30 mg/L CST Name(Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Schmitt Soil Testing,Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond,W1 54017 9/11/2013 715-760-1978 SBD-8330(8.07/00) Property Owner Mondor,Scott M. Parcel ID# 030-2061-90-000 Page 2 of 3 F ❑Boring 3 Boring# Pit Ground surface elev. 98.78 ft. Depth to limiting factor 29 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 *Eff#2 1 0-9 10yr4/3 none vfsl 2msbk mfr cs 2f 0.4 0.8 2 9-29 10yr5/3 none Ivfs lcsbk mfr gw 1Vf 0.4 0.6 c2d 10yr6/2 3 29-47 7.5yr5/6 10yr6/8 Ivfs lcsbk mfr gw 1vf 0.4 0.6 4 47-75 10yr5/6 m2d 10yr6/2 10yr6/8 sil Om mf ---- ------ 0.0 0.2 F-1 ❑Boring Boring# Pit Ground surface elev. ft. Depth to limiting factor in, ❑ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 ❑Boring Boring# Pit Ground surface elev. ft. Depth to limiting factor in, ❑ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 -Eff#2 "Effluent#1=BODS>30<220 mg/L and TSS>30<_150 mg/L "Effluent#2=BODS<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330(R.07/00) Schmitt Soil Testing,Inc. Page 3 3 3chinittsoil resling,,Inc. Na e: Scott M. M do� rhoi as J. Schmitt, ST 227 11209-1 Ad Iress: 204 10th A e. 4- luv u atak pl-111-1c, WIL a4ulu 4 eW Ric�'m d. INI�017 ho e: 60- 971 Site Address: 53�hur-h St.,Houlton, 5,1028 '00f _4 *rwal-t mnek� Ul NO: .t2 4�w . . M: .2-ap-2 1 T 7mmutmv ac ho Pit Township, Coullty: St.40sel h,$t Cr Dix C OUII ty n In IV arK I t--I 0(1.00'Top of Well. Shop "ark-PFI-99AZAkftim fsidmim-Hmmet. to 1 e= 3 Yo on our in El. 39.23' XT T- N' 00, I I _ � - oil A 41 --]-NC,-TE----De;ign�r-c�-Pkimbf r, v rify prol Lcom� j ified aft ia titne the. &Si e E aluotio wa co�ducted.� 4 O d d O N 7 N (D w K T n A Df (p A 3 3 3 p' _ ! I � O a� o m 0 o o 0 m m 0 o 0 -4 WW c j' < C c 7 3 c A> d CD 7 (D O. N �_ N W O 0 O O co N W- (D O O 3 Q N a 3 7 0 0 cn j N CD 3 = `D 0 A p O CD C CD N N Ln N N W .r CJi .► C C I w D/ CO W l'r o z D (P z D a C) H U m .. c l N ax D N Cn CD CD O N V N N O p 0! 0 2 N R C Ut C V C O � O O O O 0 0 0 Lrl n 3 N N p a D CO � vogNl co a- I°— °•o ` N . N m N I, O CD 7 N N j fu !r N zmz zcoz Q D o' 0 D o 0 o m 0 O cD °—m — O m c (0 3 n m c m• �) CD c o o C c 1 _ r _. c N -�_ O 7.. C ; N F O co � Z (p l c A w D o 0 N S CL CD y l `� s < C (n N W (D 3 N W Z v CL 3 � a 3 a o O m 3 m o N 6 CD CD N r Z7 Cl) W CD N WD'S�� D tt-0 Z0) 770 D o m` o a �1� � •m-000 C a 0 a m N O 'n i 69 N N_ W (O Co C N C (T m O co 3 7 D) O N O G 6 O N N 3 J• 0 G d 3 O < (D (O (D ! ' o N, Q N O 3 i 2 RE N O F N N — 0 = CD ° m' �0 0 a s N O o f 'O N. r. � =3 O y O =r 0 _. = DJ p N F (D _ CL < (D 7 7 O. 1 �<.O dN D N =_ad v .3o0 °—' 0 0 V v a o ° a C O 0 m °= n m C m o N N y N CD 0'O (D N [v Q 5 0 C C i cz V .0 —13 0 ohm A O N O 0 b (D CD w co 0 0 LA O CL O CL �. r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 4 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID I (� 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: Mond or, St. Joseph, Town of 030- 2061 -90 -000 CST BM ev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 27.30.20.594 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. I Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 53 Church Street Houlton, WI 54082 (Unknown 27 T30N R20W) Village of Houlton Lot 1 Blk9 Parcel No: 27.30.20.594 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Use other side for additional in Yes ] No Plan revision Required? formation. � Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) I RECEIVED f#1 @fC�.W .900 Safety and Buildings ivlsion County N 201 W. Washington Ave., P.O. Box 7162 � % . o j Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) roe 7' Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental � /A unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary S p urposes in accordance with the Privacy Law, s. 15.04 1 m , Stars. �� t G �7 1. Application Information — Please Print A Info rmation Property Owner's Name Parcel # Se TT Al0, -D 01'2 036 aj I - d -UUU Property Owner's Mailing Addr Property Location Govt. Lot City, State Zip Code Phone Number ) /a, Nl� /<, Section 4 3 (circle o T u N; R ZO E IL TY of Building (check all that apply) :3 Lot # or 2 Family Dwelling — Number of Bedrooms S / bdivision Name ,21i 0 u C lir�Gt E �' ' 1• Block # ❑ Public /Commercial — Describe Us) ❑ City of ❑ State Owned — Describe Use r Z CSM Number E ❑ VV}llage of L�YTownof 11I. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New S stem y ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ermit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner �� ► r� IV. TAe of POWTS System/Component/Device: Check all that apply) on- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound _> 24 in. of suitable soil ❑ Mound <24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) LO retreatment Device (explain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Desi n Soil A lication Rate dst D' g pp (gp ) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI, ank Info Capacity in Total # of Manufacturer Gallons Gallons Units o New Tanks Existing Tanks o R Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP /MPRS Number Business Phone Number leD Zr �b 5� 7 7 / S `�lp�— �76- � Plumber's Address (Street, CiV State Zip Code I 9 69 - ku i VII( Count /De artmentUseOnl Approved ❑ Disapproved Permit Fee t Datelssued Issuing Age�Sture ) _ ❑ Owner Given Reason for Denial IX. Conditions of Approval /Reasons for Disapproval 1 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained CLv CLr 7iz - `7vt -CL� as per management plan provided by plumber. j Q 7�- 2. All setback requirements must be maintained as per a licabie code/ Attach to complete plans for the system and submit to the County only on paper not less than 8 U2 x 1 I inches in size SBD -6398 (R. 01/07) Valid thru 0!/09 r V 1� 1 � ` PLOT PLAN PROJECT Scott Mondor ADDRESS 2040 10th Ave Star prairie Wi. 54026 1/4 1 /4S 27 /T 30 N/R 20 W TOWN St. Joseph COUNTY ST. CROIX MPRS Byron Bird Jr. 220527 11 -30 -05 BEDROOM 3 -DATE CONVENTIONAL XXXX At rade C NVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 13 LOAD RATE .5 ABSORPTION AREA 900 # of chambers 30 BENCHMARK V.R.P. Nail Maple Tree ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. Same as BM Vent SYSTEM ELEVATION T -1 =90.25 T -2 =90.15 T -3 =90.0 AT' Bio Diffuser with 31.1 f A2 per chamber 6 " at system Long 34" Elevation < to Hy 35 Access Rd 165' 65' ii Driveway 25' 190' PL 95' 3 Bed House &Shed 40' 96' 15' t 6 B2 85' B3 190' J" 62 ' 125' 15 PL 95' 25' B1 75' 25' 1 80' 165' PL PLOT PLAN PROJECT Scott Mondor ADDRESS 2040 10th Ave Star prairie Wi. 54026 1/4 1 /4S 27 /T 30 N/R 20 W TOWN St. Joseph COUNTY ST. CROIX MPRS Byron Bird Jr. 220527 ,r" ,�,,�� /Y 11-30 -05 BEDROOM 3 DATE CONVENTIONAL XXXX At rade C NVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE E3 LOAD RATE .5 ABSORPTION AREA 900 # of chambers 30 BENCHMARK V.A.P Nail Maple Tree ASSUME ELEVATION 100' ❑ BOREHOLE O WELL IH.R.P. Same as BM Vent SYSTEM ELEVATION T -1 =90.25 T -2 =90.15 T -3 =90.0 >12" Of Bio Diffuser with Cove 31.1 ft A2 per chamber 6" Long 34" Elevation < to Hy 35 Access Rd 165' o ff' 65' Driveway 25' 190' 60' PL 409 95' 3 Bed House &Shed 96' 96' 15' t 6 B2 85' 190' 62' 125' 15' PL 95' 25' BI 75' 25 1 80' 165' PL _3 -�anaftmsnt of C-Online-ce Page l 0, - Sa - s 3L _-a -`:idirias man-ce witffi Corn i I acco. Corn 8 Ad. n. Code Counti c*impem site p:;Zq on. paper rtc, less thar, 81/2 x in&.-es s4e. PIP-n must iO I but not Iim; to: ver!icaiard horizontal reference point (B: ), direction and Paice-AU.D. -0 — ' t; =-Tavv.. and ccation- and di tartce to nearest road. 3 3 � - Please print al nfa.- mraffon. Rev by- gat Pe-smna! -In-fommatior you prw:.de nay beaused for swarda" purposes (Pdva Tly "r, W- P Location ' Gov. .. o L - -t ? 1A S,:)12 T jig N Rdo E(o2- .9 er 0%VYneeS Mai , Mg Address i Lot/ Block Subd. Nam or CSIM Vo C ity NAH a g - TOM Nearest Read S : cc-d3 Ph.c.-IS Nu nit LL!n W i enti , -rn.barof riedroorns Code derived design flow irate GP i d or Plain elevation F, app NO Z rh Syr 1 n hd K) zws if . � - -.v .... - .�Ii� ^s: T ^ � = y o . mss, Q �� � CL i Boring Ufface V. in. LI P., Gmund s D epth to iimiting fadar,;7 4�' Soil Mplication. Rate De-zt� Dcmir-ant Cc-'or', Redo^- Descr Eon ext S truclure i Consist tence Boundary Roots V GPQI7,Q Rz. CO- Gr. S .'.u. nt COIV Sh. -Eff#1 1 -Eff#2 19_/01 ' 1 4 v ,, r J Z, C,7 LI �io - /IZO 90, Z's Bartn Grourd su;face a Depth to ;uniting A914, in. Soli Applicator, Rate n Dcm* Roots Boundary Structure !Consistence ry inant 0:�ori Red-ox Descrioon Tee re 1 -Dior *EfWI * GPD/W 01#2 M. SL. C-or.t. I Gr. Sz. Sh. M4 A 5 ... . ...... Effluem 507D > 30 < 22a miaiLend TSS *0 < 1150 -mafil_ EffiNuent #2 = BOD< 30 mgL ana TSS 30 m9FL CST Number —5 NeM_3 2 A*-ar=_Ss "o" Date Evaluafion Conducted Telephone Number Pr , '.�Yrner Parcel ID # rage of -7 Boring# oriitg 1 �C= pit Ground surface elev. % 8. Depth to ?;milting fac:to? in. ? Soil ApplicaWn Rate Horizon Depth Dominant Color Redox Description t Texture Structure Consistence Boundary ; Roots ; GPDAT in. tiunse ?? i Qrr. Sz Cert. Color Gr. Sz. Sh. j ! *E01 ! Joe— - { 40 I se i E 1 i Boring i—` $fin ^y Li Pit Grourid surface elev. Depth to limiting factor in. Soil Application Rate H orizon Depth DG ninant Colo r Redox Descration Texture Structure Consistence Boundary . Roots GPD/t;� i it . i1>iu,�seti Qu. Sz. Cent. Color Gr. Sz. Sh. ? *F{tl •Ggr#2 I 3 ? 1 ? t ? Boring i tjor?ng ; J Pit Ground surface elev. 't. Depth to limiting factor in. 1 Soil AprfiiCaE Rate i ^3 izG9 j Depth I Dominant Color Redox Desception ! Texture Structure j Consistence , Boundary � Roots �t � � GPD/� +� ? €r.. Afi snse ?I L2u. Sz. Cont. Color Gr. Sz. Sh. ! j t "E -,f#1 i 'Ef #2 r r t ? s t i ' I t t Elfliluert #9 = BOD > 30 < 220 mgfL and TSS >30 5 i 50 mgrL ' Effluent #2 = BOD, < 30 malt_ and TSS < 30 rngrL he DeLar`cment of Cominerce is an equal opportunity service provider and employer. Ff you need assistance to access services or reed -nWerial m an attemate formal please contact the department at 608 -266 -3151 or t'"TY 608 - 2648777. SBD 4.330 207100; Pmpe;' Owner Parcel 0 Page of Pit Ground surface elev. Dep'n to I'mitting facto in. Sou AppficaWp Rate m-craen Stric!ure Consistence Boundary' Roots GPDfft oth Dominant Colon Redox Description I Texture fw Qu. Sz. Cont. Color . i Gr. Sz. Sh WE - E t2 I or ............. " : j L5 MI B--rjqg i Bering ft. Depth to firniting factor M. Li P Ground surface elev. -ca - te on a Soli APPI. . . R. HO- zon Depth Dominant Colod Redox Description i Te xture structure Consistence Boundary I Roots GPDMF munsell QU. Sz. Cont. Color Gr. Sz. Sh. t i * Eft#1 - EM2 2 I Boring Bod- 9q;= 0 Pit Ground surface elev. ft. Depth to limiting factor_ jr. Soil Application Rate FodzO.n Depth i Dominant Color Redox Description Texture Structure Consisferm Boundary] Roof j GPDff NA L nsell Qu. Sz. Cont. Color Gr. Sz. Sh. i i * Efl#1 'Efi*2 Effluent # = BOD, > 305 220.mg/L and Tss >3o < 5o mgrL Effluent #2 = BOD,:!j 30 mg/L and TSS < 30m L .gr .' , e Department of Commerce is ar equal opportunity service provider and ernp If you need assistance to access services or need material in ar alternate format, please contact the department at 608-266-3151 or - jTY. 608-264-8777. S-Sa4330,MOMI, Soil Test Plot Plan Project Name Scott Mondor Byron Bird Jr. Address 2040 10th Ave Star Prairie Wi. 54026 ` CST #220527 Lot 1 Subdivision Blk 9 Date 1 1/30/1905 County CROIX 1/4 1/4S T 30 N /A W Township Joseph V- H Fj Boring Q Well PL Property Line# Alt. BM ,BM or VRP Assume Elevation 100 ft.Nail in Maple Tree System Elv T -1 =90,25 T -2 =90.15 T -3 =90,05 H.R.P Same as BM SCALE 1" = 40' Unless otherwise Noted < to Hy 35 Access Rd 165' 65' Driveway 25' 190' 60' PL 409 95' 3 Bed House &Shed 96' 6 B2 85' B3 190' 125' 15, PL 95' 25' B 1 75 , 25' BM 1 80' 165' PL ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM S � '6rrr Owner /� M p i Mailing Address 26 � U ' f _ - � Property Address 3 C VL( th. c,( (Verification required from Planning & Zoning Department for new construction.) City /State �ffk'�Ani f/ 1� Parcel Identification Number 03 LEGAL DESCRIPTION (' Property Location S 'W /, AJE '/a , Sec. ) 7 , T_30 N R ?C W, Town of ��'. )0��'V 4 Subdivision Plat: C�'L G� l/mac. "u �'1 , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # �� S, (before 2007)Volume , Page # Spec house yes✓no Lot lines identifiable' es 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 §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. 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 ( I ) 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 frill of sludge. I /we, 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 Commerce 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. I /we 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 SIGMATYJRtOF 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. 08/05) 8 5 0 8 5 1 State Bar of Wisconsin Form 3 - 2003 850855 QUIT CLAIM DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number Document Name ST CROIX CO., WI RECEIVED FOR RECORD 05/18/2007 11:10AM THIS DEED, made between James C. and Joyce Y. Mondor, husband and wife QUIT CLAIM DEED EXEMPT t 8 ( "Grantor," whether one or more), REC FEE: 11.00 and Scott M. Mondor PAGES: 1 ( "Grantee," whether one or more). Grantor, quit claims to Grantee the following described real estate, together with the Recording Area fixtures and other appurtenant in St. Croix County, State of Wisconsin ( "Property") (if more space is Name and Return Address needed, please attach addendum): Scott M. Mondor 5995 Oren Ave. North, Suite 142 Stillwater, Minnesota 55082 Lot One (1), Block Nine (9) in Section Twenty-seven (27), Township Thirty (30) 1 V/�L 7 North, Range Twenty (20) West, being in the Village of Houlton, according to recorded Plat. ! Z O 030. 2061.90 -000 Parcel Identification Number (PM) This is not homestead property. (is) (is not) Dated March 2007 (SEAL) (SEAL) • J es C. Mondor CAI&Qk 1 4% (SEAL) (SEAL) • Jo Y. flondor AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF MINNESOTA authenticated on ) ss. WASHINGTON COUNTY ) * Personally came before me on March 1 � 1 2007 TITLE: MEMBER STATE BAR OF WISCONSIN the above -named J ames C. and Joyce Y. Mondor (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. D THIS INSTRUMENT DRAFTED BY: b * Francis J. Rheinber r Francis J. Rheinberger, Rheinberger Law Office Notary Public, State siPRANCIS d. RHEINBEROMM 5995 Oren Ave. North, Stillwater, Minnesota 55082 My Commission (is p (expireN j 1 201 ) (Signatures may be authenticated or acknowledged. Both a a ry ) . .M� NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FO Type name below signatures. ® 2003 STATE BAR OF WISCONS 3 2003 1 of 1 Parcel #: 030 - 2061 -90 -000 11/12/2007 08:17 AM PAGE 1 OF 1 Alt. Parcel #: 27.30.20.594 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: P � 7 Owner(s): O = Current Owner, C = Current Co -Owner O - MONDOR, SCOTT M SCOTT M MONDOR � 1 20 ►/ ' ��" G J �O f�� WI 54026 / Vo 2 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description _ SC 2611 HUDSON L, LeVI SP 1700 WITC Legal Description: Acres:' 0.72 Plat: 02- 022 - HOULTON SEC 27 T30N R20 LOT 1 BLK 9 VIL HOULTON Block/Condo Bldg: 9 LOT 1 Tract(s): (Sec- Twn -Rng 401/4 1601/4) may, 27- 30N -20W Notes: Parcel History: Date Doc # ,� VoUP ` Type _ 05/18/2007 850855 J U f -� r ewyv— QC 760f 07/23/1997 �_ �./ 1232/346 QC 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/16/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.720 17,300 23,100 40,400 NO Totals for 2007: General Property 0.720 17,300 23,100 40,400 Woodland 0.000 0 0 Totals for 2006: General Property 0.720 17,300 0 17,300 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 n CA o-V n o k it t \ / \ m q / $ D k i 0 M ~ 0 * f ° -4 ° a } ( / \ i ° � Q ) ' , o : o 9 g E o } = - < ! \ 6 2 a ° 2 a \ a l 0 ] CD \ \o \ _ E E g ! G 7 E 0 £ / §f (�� _ \° a G e 0 \ c g 0 c \ T 3 0 0 :E rr e - \ J\ Ch a 0 A 7 E J / 2 D ; I m & [ (/ 0 a c ƒ g o \ ¥§&/ /ƒ \ �� �� \ \\ > 4 / %C ` {20 p o \ = w . mo C z . {K 0 { § z I 7 0 . § z § ® / z § C A) o E; C/) y 0 CO m =\ § \ /., 2 / \ %Rz a \e0 << \E \RE { a&Ek� ; \«&i\ ® ® o =: \� \< =r<. ( E\aeo \�°£\ / \ =3 \ \(D � . \ ( \\ % E ~ a CD < \ 0 \ E \ 0 N A 9+ O ° c 0 ? 0 3 _ R_ A: ." O o m v, o 00 o to --4 ° w � � • < c OD m is ° N N EL y o 0 (n CD O 00 n CD 3 SAO O 0 0 a o y � o m y cn O O I d m n ° R cn z D O 3 ♦� D � m 0 c _ I p � z O o 0 0 Q I s cn v v v 0 0 0 o0 0 Ln < Q a to v� to o W co v o N o I � d _ C _ CA 0 I m c z w z O D o p Z vO m p7 CD W a p m C N H• Ul O y In ' O LU ID C a • D v CD or r a - n M C m CD a, (n D 0 'I N 5 -- I N \ :3 cn --I M m CD a o 00 - ::E w o m N 3 z oo z o I ' 3 3 m c m _ °- m a w � cn D o a m o 1 Q C y CD Q CD ID C h �- N j V \ v O C\ C V A O C+d I m aro N p p a J o CD Parcel #: 038 - 1090 -20 -000 11/12/2007 08:39 AM PAGE 1 OF 1 Alt. Parcel #: 21.31.18.369 038 - TOWN OF STAR PRAIRIE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - LEVY, JOSEPH F& MARY E STEWART JOSEPH F& MARY E STEWART LEVY 2040 110TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 21 T31N R18W NE SE Block /Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 21- 31N -18W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1008/01 WD 07/23/1997 981/114 WD 07/23/1997 912/37 07/23/1997 718/440 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 25,000 145,600 170,600 NO UNDEVELOPED G5 39.000 70,500 0 70,500 NO Totals for 2007: General Property 40.000 95,500 145,600 241,100 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 95,500 145,600 241,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 307 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 CIA k-- kj fN J'y PLANNING & ZONING FAX MEMO DATE: Post -it' Fax Note 7671 Dategf z -7 67 # or pages To sc t � C1 �"6C>n Q ✓ Fro TO. Co. /De t. P Co _ Phone # f - c � C Code Administration,, FAX NUMBER i - Lq kj - 700 Phong # 715 -386 -4680 Fax #�5 _ Fax # ! S ss(�o ^ g� Land Information FROM: Planning 715 386 -4674 FAX NUMBER 715 - 386 -4686 Rea property PHONE NUMBER: - 386-4677 Re g NUMBER OF PAGES, INCLUDING COVER SHEET 715 x$6-4675 RE: X F` t h` ST. CRO /X COUNTY GOVERNMENT CENTER PZ@CO SAINT -CROIX W I US 1 7O1 CARn' ROAD. HUDSON, WI 54016 715 386-4686 FAX WWW CO SAiNTCROIX Wl US PA f S an i ings l5ft1dY County 1 *is 201 Was ' n e., P.O. Box 7162 `i 0 il 7 r - COnSli11 icon, 07 { 7I(2 t 1}+ 4 rtary P ermit Number (to be filled in by Co.) Department of Commerce 8) 2 �1 0 00 Sanitary Permit Applicatio sl CROIX COO to P► nl.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal infonnation may be used for secondary purposes Privacy Law, s15.04(1)(m) P oject Address (if different than mailing address) I. Application Information - Please Print All Information 4 Ct+cti�c r C ` . Property Owner's Name r Parcel # t # Block # -e!• Property Owner's 4AM Property cation %., V,, Section City, State Zip Code Phone Number �Gc' f^ ��Lf <� ' G . S Qv�� 7 � �� T /d N; RE 1� 1 - 5 II. Type of Building (check all that apply) or 2 Family Dwelling - umber of Bedrooms Subdivision Name CSM Number El Public /Commercial - Describ Use _ ❑ State Owned - Describe Use ❑Ci p y Towgship of Q l B III. Type of Permit: (Check only o)v box on line A. Complete line B if plicable) 6 3b -ZJDG — o - pap , A * 0 New System ❑ Replaceme System ❑ Treatment/Holding ank 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. Type of POWTS System: Check all that a 30 Non - Pressurized In- Ground ❑ Mound > 24 in. of sui ble soil Mound < 24 in. of suitable soil El At -Grade El Single Pass Sand Filter El Constructed Wetland El Pressurized In- Ground ❑ Holdin Tank ❑Peat Filter ❑ Aerobic Treatment Unit El Recirculating Sand Filter El Recirculating Synthetic Media Filter hing Chamber rip Line ❑Gravel-less Pipe [I Oth explain) V. Dis ersaVFreatment Area Information: A 7e Design Flow (gpd) Design Soil Application Rate(gpdsf) is rsal Area Required (sf) Dispersal kea Proposed s stem Elevattion�r ft VI. Tank Info Capacity in Total Number Manufacturer Prefab, to Steel Fiber Plastic Gallons Gallons Units Concrete Constructed Glass New I Existing Tanks Tanks S tic Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installIption of the POWTS shown on the attached plans. Plumber' Name (Print) / Plum gnature MP/M S Number Business Phone Number P►u rs (Street, City, State, Zip C 1, VIII. County/Department Use Onl yA pproved ❑ Di ved ea§ for Denial Sani ermit Fee includes Groundwater "Date Issued Issu g Agent Signan (No Stamps) Surcharge Fee) ??�� El en R IX. Conditions Appr ��� SYSTEM OWNER: 1 Septic tank, effluent filter and r dispersal cell must all bg serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 8112 x 11 inches in size SBD 6398 (R. 01/03) �� sr. 1. ROM COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address ��O �� /� f� •.�,� ��,,,, � u � �� i -c �. � �� / Property Address GC Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number 3 c? l' b - LEGAL DESCRIPTION Property Location I/4 , '/4 ,Sec. 0 T o ON R pulp W, Town of Subdivision ` Lot # �. Certified Survey Map # ( , Volume �- , Page # Warranty Deed # - 4 �2 7 , Volume , Page # d Spec house yes �' Lot lines identifiable (59� 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 §Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. 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. I/we, 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 Commerce 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. Uwe 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 _ SI NATURE 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. 08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _ I of FILE INFORMATION r - -- V4A& V0fj ' 6WAJC -<- SYSTEM SPECIFICATIONS Owner d1z �. C g Septic Tank Capacity 4 a l 13 NA Permit # Septic Tank Manufacturer e eh ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units A Pump Tank Capacity al ❑ NA Estimated flow (average) 5'!J gal /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) O gal/day Pump Manufacturer ❑ NA Soil Application Rate gal /day /ft' Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average` Pretreatment Unit WNA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Tota Suspended Solids (TS S) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L - Wn- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510" cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * 'Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ,0 ears) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) 13 NA years) Clean effluent filter At least once every: ❑ IEKearearls) yw month ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ m ) I NA ❑ yeaarr(s(s) ) Flush laterals and pressure test At least once every: ❑ month(s) TINA ❑ year(s) Other: At least once every: ❑ month(s) A ❑ year(s) Other: }� ` 1 NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services including but not limited h filters, mechanical or pressurized components, pretreatment ted t the servicing effluent fdte a . Pr units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page . of._ START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • 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 replacement 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. I ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name ' ,. Name Q Phone Phone �� SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name G V-0 At Phone G Phone `� ,6 d ve Code. This document was drafted in compliance with chapter Comm 83.22(2)Ib1111(d) &(f) and 83.54111, 12► & (3), Wisconsin Administrative Me. 619. Warrants Dead - -By Corporation. (STATE OF W16CO3iY1,1!i) Published by Eau Claire Not • itatlanay Co. —Short Form. (See. 235.16, Wis Statutes) corm 4 4 '4`0 '1 < IL < rhi;i. J ' 7 is Atbrnturr Made by AMERICAN CANCER SOCIETY, INC... a New York -Corporation, Grantor, of the City of New York, State of New York, w Yor ' a Corporation duly organized and existing under and by virtue of the laws of the State of AWE hereby conveys and warrants to JAMES C. MONDOR and JOYCE Y. MONDOR, Husband. .and Wife, grantees ' 01 County, Wisconsin, for the sumof One Dollar ($1.00) and other good and valuable consideration, the following tract of land in St. Croix County, State of Wisconsin: Lot Two (2), Block Nine (9) being in the Southwest Quarter of the Northeast Quarter (SW4 - NEB) of Section Twenty -seven (27), Town- ship Thirty (30) North, Range Twenty ( 20) West in Village of Houlton, and Lot One (1), Block Nine 9) in Section Twenty -seven (27), Township Thirty (36) North, Range Twenty (20) West, being in Village of Houlton, according to recorded Plat and all that parcel of land described as follows, to -wit: Commencing in Southeast corner of lands conveyed by Mary Ann Sullivan to one Daniel Sullivan, as shown by deed recorded in book "70" on page 474, in office of Register of Deeds of St. Croix County; thence South Two (2) rods; to South line of Southwest Quarter of the Northeast Quarter (SW�I - NE of Section Twenty -seven (27), Township Thirty (30) North, Range Twenty (20) West; thence West to Hudson and Houlton road; thence Northwesterly along the East line of said road to a point West of the place of beginning; thence East to the place of beginning. This deed is pursuant to the terms of a certain land contract recorded in the office of the Register of Deeds, Volume 396 RECORDS, p. 127 -128, and the warranties contained herein do not include any acts.or transactions of the grantees after July 10, 1963 313 Witnt00 Wbttrot, the said grantor has caused these presents to be signed by .Wendell G. Scott , its President and countersigned by Charles R. Ebersol , its Secretary,4* at New York, New York , Wieveosio, and its cdrporate seal to be hereto aftxed, this 12th day of Dlovember , A. D., 1963 Signed and Sealed in Presence of 1A i'ICAD' CIII �CTT SO4 Ty ,., 11"G. --� �j �f✓ ,� f � % � � ['.orp0>: lime . / ._�........ President Wendell G. Scott,,M. D. ter ed: 4 - f J UVice' Pre dent for Administration Charles R. Eber Q d1 YORK %tdtt pV�iV4 ss. courPY CE Y. Y. County. . Personally came before me this 12th day of D ?ovember , A. D., 1963 Wendell G. Scott President, and Charles R. Ebersol Secretary of the above named Corporation, tome known to be the persons who executed the foregoing instrument, and_to me known to be such - President and Secretary of said Corporation, and acknowledged that they executed the foregoing instrument as such officers as the deed of said Corporation, by its authority. 6 L7_7 �• 1Pth .._.. arh ubs ,r ` !ow Y,a1 ,f_ I�oyemer ",.rJ.13� ., :3...____P, iM. Notary Public, Q ei;i �� � aunty �' Y, 0 � y y � . � Grt . . filed in ew vc.�. �ou 41f M Commission expires ��+ D 19 r passion Ex March a0, 1!!♦�? y P *1 , Draf i r f Deeds 9 Win. State. provides that AN nstrnments N • ry printed or type- ton thereon the names of the `rantors, ¢rantees, witnesses and notary.) - ` - , 13. >2. 11. 10. 9• IL x. � i -rte j(1y y w I LOCf(. o O �C Cli AA 26 t, i 9TREOT - 3 z, L iS > r i T� _.,.y • � ,�:.�� i tin