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572821 030-2061-90-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(ri Permit Holder's Name: City Village X Township Mondor, Scott M. I St. Joseph, Town of CST BM Elev: Insp. BM Elev: BM Description: CC yz ���j y2 , jz TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic _ lob Dosing VV K. Aeration Holding TANK SFTRACK INFORMATION TANK TO P/L, �VV /� WELL BLDG. VenttoAirintake n ROAD �> Septic Dosing 5_� ' ch a n r, Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft _, Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM tLtVA 1 lUN UA 1 A County: St. Croix uu -1 Sanitary Permit No: 572821 0 State Plan ID No'. Parcel Tax No: 030-2061-90-000 Section/Town/Range/Map No: 27.30.20.594 STATION BS HI FS ELEV. Benchmark, Alt. BM Bldg. Sewer SUHt Inlet (, 3 1 1 SUHt Outlet DtInlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cove nA BED/TRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer: SETBACK INFORMATION Type Of System: 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: /2/ / }' Inspection #2: tt � Location: 53 Church Street Houlton, WI 54082 (SW 1/4 NE 1/4 27 T30N R20W) Village of Hou ton Lot 1 Blk9 Parcel No: 27.30.20.594 1.) Alt BM Description = c)ti1%� ��x� ' G� 2.) Bldg sewer length = � / jol - amount of cover = Plan revision Required? Yes _J No I Use other side for additional information. _—__ rt. N- Date Insepctor's Signature Ceo. SBD-6710 (R.3/97) PLOT PLAN Project Name: Mondor 3 Bedroom Mound Legal Description: SW114, NE114, S27, T30N, R20W P.I.D: Subdivision Name: Plat of Houlton Lot #: Township: ST. JOSEPH Parcel Size: County: ST. CROIX Contour Line Elevation: 99.28' Cell Dimensions: System Elevation 102.33' Mound Dimensions: Slooe: 3% A BM1 Elevation: 100.00' ITopofWell A BM2 Elevation: 99.42' 113ottom of siding ■ Backhoe Pits 030-2061-90-000 1 0.72 Acres 6' X 75' 91.29' x 20.85' N SCALE: V = 30' 4 inch Sch 40 -ASTM D2665 2 inch Sch 40 -ASTM D1785 11/2 Sch 40 -ASTM D1785 Paae 11 a.® Vt"11 St. Croix County Planning and Zoning Thursday, October 30, 2014 at 3:46:53 PM Detail Sanitary Information Page 1 of Computer #: 030-2061-90-000 Sub/Plat: Village of Houlton Section: 27 Parcel #: 27.30.20.594 Lot: 1BIk9 TN/RNG: T30N R20W Municipality: St. Joseph, Town of CSM: 1/4 1/4: SW 1/4 NE 1/4 Owner: Mondor, Scott M 53 Church Street Houlton, WI 54082 State Permit: 572821 Issued: 10/2012014 POWTS Dispersal: Mound 24" or more suitable soi Permit: New County Permit: 0 Installed: POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Requirements Additional Notes Money Owed Ryan Yarrington >411/00 - Not Required Schmitt, John F. MP# P. Quinn inspected tank installation 1000/650 Wieser tank with Polylok 525 filter, $0.00 Not determined Signed Off: No 10/30/14 - John says mound won't go in this Zoeller 152 pump and 6'x75' mound cell. year. Permit paperwork placed back in the blue folder Owner: Mondor, Scott M. 53 Church Street Houlton, WI 54082 State Permit: 514813 Issued: 12/05/2007 POWTS Dispersal: Non -Pressurized In -ground County Permit: 0 Installed: POWTS Detail: Bio Diffuser (11") (PSA) POWTS Pretreatment: NA Notes IssuerlInspector As Built Pam Quinn NA Not determined Signed Off: No Permit: Renewal Bedrooms: 3 WI Fund: Plumber Other Requirements Bird, Byron Jr. as of Feb. 2008 Brady Utgard was to come in and apply for transfer of permit, but nothing done as of 3/12/09 Additional Notes Money Owed owner came in 12/5 and paid for renewal - keeping $0.00 permit card in file and don't release until either Byron signs form or until a different plumber applies for change prior to installation of POWTS. Will need transfer of plumber, new plot plan & $85 fee for revision. Should have Byron's signature on the application - processed with verbal OK by plumber to renew under his name. St. Croix County Planning and Zoning Thursday, October 30, 2014 at 3:46:53 PM Page 2 of 2 Detail Sanitary Information Computer #: 030-2061-90-000 Sub/Plat: Village of Houlton Section: 27 Parcel #: 27.30.20.594 Lot: 1BIk9 TN/RNG: T30N R20W Municipality: St. Joseph, Town of CSM: 1/4 114: SW 1/4 NE 1/4 Owner: Mondor, James 53 Church Street Houlton, WI 54082 State Permit: 488018 Issued: 12/05/2005 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 0 Installed: POWTS Detail: Bio Diffuser (1 V) (PSA) Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Requirements Additional Notes Money Owed Kevin Grabau NA Bird, Byron Jr. Scott M. received property via QC deed in 2007 $85.00 Not determined Signed Off: No May require revision with additional soil testing due to well being located <50 ft. from current tested area (per Tom Mondor's site visit) Byron was paid 11/22/07 for this permit Safety and Buildings Division County / , C /C-) D / X Sanitary Permit Number (to be filled in by Co.) 201 W. Washington Ave., P.O. BOX 7162 Madison, WI 53707-7162 DECEIVED State Transaction Number Z y 6 76) 80 Sanitary Permit Application N form to the al jriat 7o mmental unit In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this is required prior to obtaining a sanitary permit. Note: Application forms for state- ed to the Department of Safety and Professional Servics. Personal information youuM, j Project Address (if different than mailing address)I ) V' 4 purposes in accordance with the PrivacyLaw, s. 15.04 1 m , Stats. M _ 5 r� t s" IC I. Application Information — Please Print All In ation Parcel # Property Owner's Name / Property Owner's Mailing Address Property Location 2 O /� D D7i� / 1 v IC Govt. Lot (/ (% y; /V 1/A, Section % City, State Zip Code Phone Number _ S' f�i �f � � 1/0Z6 cle one) T .;7© N; R �' E o�V II. Type of Building (check all that apply) Lot # j Subdivision Name 1 or 2 Family Dwelling — Number of Bedroo Block ` PL 1u'' t As p f t t 1 Use A4'T vl ❑ Public/Commercial —Describe El city of CSM ❑ State Owned —Describe Use El Village of � Town of S� J D5 C P l/ Number � III. Type of Permit: (Check only one box on line A. Complete line B if applicable) %New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) RB. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑Permit Transfer to New List Previoyt��� Dumber and iiate�ssue �� `j Before Expiration Owner IV. Type of POWTS S stem/Com onent/Device: Check all that apply) D A v✓ ❑ Non -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) ❑ P treatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate( dsf) Dispersal Area Required (sf) Dispersal Area Proposed System Elevation //Z /lZ 5 /Ov.l I VI. Tank Info Capacity in Gallons Total Gallons # of Units Manufacturer 2 j y —' 1 / / I �� o a Z fr,LL, 2 o v = =a New Tanks Existing Tanks Septic or Holding Tank / Q ©O / pE�O / e / C6 Dosing Chamber (oj D 650 1. VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Sianaturq, MP/MPRS Number Business Phone Number OH N -r. /-T ��' ZZ3 7C� 71S - 7� o -0 �/ 8 Plumber's Address (Street, City, State, Zip Code) V11"ounty /De Use Only Permit Fee Date Issuing ent Signatur pproved 3\artment � $ w� � DID /6 L;;d eason for Denial IX. Cond%P83@MAaVWffRWcasons for Disapproval dpC— ' 3> iio� ���� 1. Septic tank, effluent filter and V4-•c �� be services / maintained W I dispersal cetl must all e _k_ as per management plan provided by plumber. f 2. AN setback requirements must be maintained fe �V (; ,� /U1 Ub P� ais per applicable code / ordinances. MUM to compiete pians for me system una sautnn .., tn- J J — r-r- ••••• SBD-6398 (R. 11/11) October 13, 2014 CUST ID No. 223760 JOHN F SCHMITT SCHMITT & SONS EXCAVATING 616 150TH AVE SOMERSET WI 54025 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/13/2016 SITE: Mondor 53 Church St Town of Saint Joseph St Croix County SW1/4,NE1/4, S27, T30N, R20W Lot: 1, Block: 9, Subdivision: Plat of Houlton FOR: DIVISION OF INDUSTRY SERVICES 3824 N CREEKSIDE LA HOLMEN WI 54636 Contact Through Relay http://dsps.wi.gov/programs/industry-services www.wisconsin.gov Scott Walker, Governor Dave Ross, Secretary ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No. 2467080 Site ID No. 807108 Please refer to both identification numbers, above, in all correspondence with the agency. Description: Mound / Three Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object IDNo.: 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.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, 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. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • 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 145.1-9, 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 5EE JOHN F SCHMITT Page 2 10/13/2014 • SPS 383.22(7) A cry 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, Charles L Bratz POWTS Reviewer 2 , Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday - Friday charles.bratz@wisconsin.gov Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Please Include a Copy With Your Payment Submittal. WiSMART code: 7633 cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484 , Monday - Friday 8:00 am To 4:30 pm JOHN F SCHMITT 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, / 4 / . Charles L Bratz POWTS Reviewer 2, Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday - Friday charles.bratz@wisconsin.gov Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Please Include a Copy With Your Payment Submittal. WiSMART code: 7633 .s cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484 , Monday - Friday 8:00 am To 4:30 pm MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Mondor 3 Bedroom Mound 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 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 & 10 Page 11 Page 12 Page 13 Page 14 Attachment Designer: John Schmitt Index and title Data entry Mound drawings Lateral and dose tank System maintenance specifications Management and contingency plan Septic and Dose tank specifications Effluent filter information Pump specifications and curve Plot plan Septic tank maintenance agreement Warranty deed CSM Soil evaluation report License Number: 223760 Date: 9/22/2014 Phone Number: 715-760 NC .,0 RR Signature: y? 7Xq-f,,,,_ff 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 DNALLY ;OVED 3AFETY AND INAL SERVICES DUST SERVICES DUS Mound and Pressure Distribution Component Design Design Worksheet Site Information 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 fecal coliform of - 36 inches. 1.50 Peaking Factor (e.g. 1.5 = 150%) 450.00 Design Flow (gpd) 3.00 Site Slope (%) 99.28 Contour Line Elevation (ft) 26.00 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd/ft2) Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) _ 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Pressure Disribution Information C Center or End Manifold 3_._0 -01 Lateral Spacing (ft) 4 Number of Laterals 0.188 Orifice Diameter (in) 2.50 s = Orifice Spacing (ft) _ 2.00 Forcemain Diameter (in) 75.00 Forcemain Length (ft) 91.00 Pump Tank Elevation (ft) Project: q.70 System Head (ft) x 1.3 Vertical Lift (ft) Friction Loss (ft) 0.00 In -line Filter Loss (ft) 14.341 Total Dynamic Head (ft) Lateral Diameter Selection in. dia. options choice x x x x x 0.75 1.00 1.25 1.50 2.00 F] 3.00E 6.00 Cell Width (ft) Are the laterals the highest point in the distribution Y network? _ If N above, enter the elevation (ft) of the highest point. 7.50 ft2/orifice Does the Forcemain drain back? Y Enter Y or N 12.23 Forcemain Drainback (gal) 5x Void Volume (gal) Minimum Dose Volume (gal) System Demand (gpm) 67.32 79.55 39.32 Manifold Diameter Selection in. dia. options choice 1.25 1.50 x x 2.00 x 3.00 Gallons/Inch Calculator _nuonar Treatment Tank Information Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser Concrete Manufacturer gal/in (enter result in cell B49) Dose Tank Information 650.00 Dose Tank Capacity (gal) 17.00 Dose Tank Volume (gal/in) Wieser Concrete Manufacturer Mondor 53 Church Street Effluent Filter Information Polylok� Filter Manufacturer 525 Filter Model Number Page 2 Mound Plan and Cross Section Views L' Mound Component Dimensions A 6.00ft E 12.16in 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 (ft2) Dispersal Cell Area 1125.00 (ft2) 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) > G 1 I F Dispersal Cell 100.61 (ft) Latera 00.11 (ft) — ' : 1Invert Dispersal Cell Elevation E D r 5 99.28 (ft) Contour Elevation 3.0 % Site Slope Geotextile Fabric Cover Shading Key a T Dispersal Cell See lateral details on 10 Topsoil Cap o a 1.5 ft Page 4 for number, size, and spacing of laterals. Subsoil Cap N o © ASTM C33 Sand 1° `4 F Laterals are equally a spaced from the Typical Lateral ® ��] Tilled Layer c y 0.5 ft distribution cell's © Aggregate centerline in the A __♦ distribution cell (AxB). Project: Mondor 53 Church Street Page 3 Center Connection Lateral Layout Diagram Force main connection via tee or cross to manifo'd at any point �= Turn-u p vd ba I I valve o: Ir X cleanoutpiug Hoes dnCed on the bottom of the I aterai Laterals are identic ai ::12�I Laterals 5forcemain Sch 40 PUC per SPS Table 384.30-5 Number of Laterals Lateral Diameter Lateral Length (P) Lateral Spacing (S) Lateral Flow Rate System Flow Rate Total Dynamic Head Orifice Diameter in Orifice Spacing (X) ft Orifices per Lateral ft Orifice Density gpm Manifold Length gpm Manifold Diameter ft Forcemain Velocity in ft ft2/orifice ft in ft/sec 4 0.188 1.50 2.53 36.69 15 3.00 7.50 1 9.83 3.00 1 39.32 1.50 14.34 4.02 Dose Tank Information Electrical as per NEC 300 and --� SPS 316.300 WAC Disconnect — Tank component is properly vented Wieser Concrete Manufacturer Capacityl 650.00 Gallons Volume 1 17.00 gal/inch Dimension Inches Gallons A 20.56 349.45 B 2.00 34.00 C D Total 4.68 11.00 38.24 79.55 187.00 650.00 T A B C —t dinq un er tank. Alarm Manuafacturer SJE Rhombus Alarm Model Number AB Pump Manufacturer Zoeller Pump Model Number 152 Pump Must Deliver 39.32 gpm at F 14.34 ft TDH Project: Mondor 53 Church Street Locking cover with warning label and locking device and sealed watertight 4 in. min. E -- Alternate outlet location Forcemain diameter �t 2 in. Weep hole or anti - siphon device Pump off elevation (ft) 91.92 Dose tank elevation 91 .00 Page 4 Mound System Maintenance and Operation Specifications Service Provider's Name John Schmitt Phone 715-760-0486 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 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Service Frequency Inspect and/or service once every 3 years Should inspect and clean at least once every 3 years Test once every 3 years Should test month) Laterals should be flushed and pressure tested every 3 years Inspect for pondinq and seepage_once every 3 years___—] � t, e 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 0 Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution 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. 01101, 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 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 r i 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 s equipped with an alarm, the 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 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 Svstem 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 BOD.5, 30 mg/L TSS, 10 mg/L FOG, and 104cfu/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. Continaencv 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 V)0 w INLET L0 146" TOP VIEW 1" CAST -A -SEAL OUTLET PAD SIDE VIEW TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS WLP1000/650-MR TANK SPECIFICATIONS DIMENSIONS: WALL: 3" BOTTOM: 3" COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 54 1/2" O.D. LENGTH: 146" O.D. WIDTH: 84" O.D. BELOW INLET: 43" O.D. LIQUID LEVEL: 38" WEIGHT: BOTTOM 14,940 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET, CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: � 6.3 GAL% N PUMP) ) LOADING DESIGN: 8' 0" UNSATURATED SOIL MN TANKS: WILL HAVE ONE VENT OVER OUTLET AND WILL HAVE TWO VENTS IN COVER OVER INLET TANK CAN BE USED AS: SEPTIC/SEPTIC, SEPTIC/ PUMP OR SEPTIC/SIPHON COVER: MIX DESIGN #8 NO FIBER) TANK: MIX DESIGN #10 STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE JOB INFORMATION: CUSTOMER: JOB NAME: DATE NEEDED: APPROVED BY: APPROVAL DATE: 0 O o a a V) w s 0 a a 0 II a J 1 H a w of U O N 0 N w > s m cn a m a � w a f-- 0 � J � Q CV 1 :D Q Z Q O O U p O F w d V) w j Enw tr SHEET NO. OF 1 PD E SDK Inc wnovancos in Precast Drainage sr�� Zabel' & mtiastewafer Prodwecfs �I n Division M FdsAok Irx: PL-525 Effluent Filter 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 525 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: • Rated for 10,000 GPD (gallons per day). • 525 linear feet of 1/16" filtration. • Accepts 4" and 6" SCHD 40 pipe. • Built in gas deflector. • Automatic shut-off ball when filter is removed. • Alarm accessibility. • Accepts PVC extension handle. I'I_-52.5 Installation: Ideal for residential and commercial waste flows up to 10,000 gallons per day (GPD). 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary. 3. Glue the filter housing to the 4" or 6" outlet pipe. If 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. 5. Replace and secure the septic tank cover. PL-525 Maintenance: The PL-525 Effluent Filters will operate efficiently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three vears. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. 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 sure the filter is properly aligned and completely inserted. 7. Replace and secure septic tank cover. 0 6„ Filtration Slots Alarm switch 10,000 GPD (Optional) -� Accepts 1" PVC Extension Handle Accepts 4" & 6" SCHD 40 pipe Rated for 10,000 GPD 525 Linear Ft. of 1/16" Filtration Slots Certified to I (a NSF/ANSI Standard 46 L Outdoor SmartFilter, e: Alarm Polvlok, Zabel & Best filters accept the SmartFiltea switch and alarm. Gas Deflector Imatic -Off Ball Fxtend & Lokr" Easily installs into existing tanks. Polylok. Inc. 3 Fairfield Blvd. Wallingford. CT 06492 Toll Free: 877.765.9565 Fax 203.284.8514 www.polvlok.com Page 8 �% /p�7p SECTION: 2.20.047 19 ,%UQL/TV PUMPS 91NCE /�/J�/ ///�Q' FM0110 7&,,�, 1 J c ,70 Supersedes Product information presented F�7 � a•� � 'm v 1108 here reflects conditions at time P7ZIIWP fO of publication. Consult factory regarding discrepancies or visit our web site: inconsistencies. MAIL TO: PC. BOX 16347 • Louisville, KY 40256-0347 SHIP TO: 3649 Cane Run Road • Louisville. KY 40211-1961 www.zoeller.com (502) 778-2731. 1(800) 928-PUMP • FAX (502) 774-3624 COMPARE THESE FEATURES • Durable cast iron construction Model 151 comes standard with a glass -filled polypropylene base • Corrosion resistant powder coated epoxy finish • Stainless steel lifting handle • Assembled with stainless steel bolts • Non -clogging engineered thermoplastic vortex impeller design • Model 151 -1/3 HP passes''/2" spherical solids • Model 152 - .4 HP passes 3/4" spherical solids • Model 153 -1/2 HP passes 3/4" spherical solids • Motor - 60 Hz, 3450 RPM, oil -filled, hermetically sealed, automatic reset thermal overload protected • Carbon/Ceramic seals • Upper sleeve bearing and lower ball bearing running in bath of oil • 20 ft. UL Listed power cord with molded 3-wire plug • 1'/2" NPT vertical discharge BN and BE standard models include a 20 ft, variable level float switch • Operates at temperatures to 130OF (54°C) in effluent applications • All models include a 1'/2" x 2" PVC adapter fitting Note: The sizing of effluent systems normally require: variable level float(s) controls and properly sized basins to achieve required pumping cycles or dosing timers with nonautomatic pumps. O PUMP fZ7, MAIL TO: PC. BOX 16347 Louisville, KY 40256-0347 SHIP TO: 3649 Cane Run Road Louisville. KY 40211-1961 (502) 778-2731. 1(800) 928-PUMP FAX (502) 774-3624 Manufacturers of ... 15111521153 EFFLUENT SERIES (For Pump Prefix Identification see News & Views 0052) "oos E=MATE" FOR SEPTIC TANK - LOW PRESSURE PIPE (LPP) AND ENHANCED FLOW STEP SYSTEMS .w' l EFFLUENT o.4: SUBMERSIBLE ` 11/2" NPT DISCHARGE MC N1 BIN pa 1r: QL/.dL/TY /-LIMPS �NCE Ol��/ ' © Copyright 2010 Zoeller Co. All rights reserved. Page 9 PUMP PERFORMANCE CURVE •D.c 35 30 OREGON 05110,WRIM 20 151 ■�■,. ■■ LITERS 0 40 8o 120 160 200 240 280 320 360 FLOW PER MINUTE 014508A CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available • Electrical alternators, for duplex systems, are available and supplied with an alarm • 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 • Sealed Qwik-Box available for outdoor installations - See FM1420 • Over 130°F (54°C) special quotation required 151/1521153 Series 15111521153 MODELS Control Selection Model Volts -Ph Mode Amps Simplex Duplex N 151 115 1 Non 6.0 1 2 or 3 BN151 115 1 Auto 6.0 Included 2 or 3 El 230 1 Non 3.2 1 2 or 3 BE151 230 1 Auto 3.2 Incil ded 2 or 3 N152 115 1 Non 8.5 1 2 or 3 BN152 115 1 Auto 8.5 Included 2 or 3 E15 230 1 Non 4. 1 or E15 0 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN153 115 1 Auto 10.5 Included 2 or 3 E153 230 1 Non 5.3 1 2 or 3 BE153 230 1 Auto 5.3 Included 2 or 3 SELECTION GUIDE TOTAL DYNAMIC HEADIFLOW PER MINUTE EFFLUENT AND DEWATERING MODEL 151 152 153 Feet Meters Gal. Liters Gal. Liters Gal. Liters 5 1.5 50 189 69 261 77 291 10 3.0 45 170 61 231 70 265 15 4.6 38 144 53 201 61 231 20 6.1 29 110 44 167 52 197 25 7.6 16 61 34 129 42 159 30 9.1 — — 23 87 33 125 35 10.7 — — — — 22 85 40 12.2 — — — — 11 42 Shut -of Head: 30 ft. (9.1 m) 38 ft. (11.6m) 44 ft. It 3.4m) 014508B Model 151 Models 1521153 61132 --- f 6732 3718 45/8 —' 3718 e e ' 3 7I8 3 7M 9 I.- ® 3 718 3718 —� H — 1 1? NPT Ji 11 11/76 12 118 _ 7 T — 415716 S 318 y- SK2444 SK2064 Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. 2, See FM0712 for correct model of Electrical Alternator E-Pak. 3. Variable level control switch 10-0743 used as a control activator, specify duplex (3) or (4) float system. 0 CAUTION All installation of controls, protection devices and wiring should be done by a qualified licensed electrician. All electrical and safety codes should be followed inclucing the most recent National Electrical Code /NEC) and the Occupational Safety and Health Act(OSHA). "Easy assembly" (pump & discharge pipe not included.) OPTIONAL PUMP STAND PIN 10.2421 Reduces potential clogging by debris Replaces rocks or bricks under the pump Made of durable, noncorrosive ABS Raises pump 2• off bottom of basin Provides the ability to raise intake by adding sections of 1'/2• or 2• PVC piping Attaches securely to pump Accommodates sump, dewatering and effluent applications NOTE: Make sure float is free from obstruction. 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 Project Name: Mondor 3 Bedroom Mound Legal Description: SW114, NE114, S27, T30N, R20W P.I.D: Subdivision Name: Plat of Houlton Lot #: Township: ST. JOSEPH Parcel Size: County: ST. CROIX Contour Line Elevation: 99.28' Cell Dimensions: System Elevation 102.33' Mound Dimensions: Slope: 3% A BM1 Elevation: 100.00' JTop of Well 0 BM2 Elevation: 99.42' 113ottom of siding ■ Backhoe Pits 030-2061-904000 1 0.72 Acres 6' X 75' 91.29' x 20.85' Rj.K eH0PC ► s, �R1vFU��` H o"s VAIIELi- BM G J ID U0/ o cif 1 � SCALE: 1" = 30' 4 inch Sch 40 -ASTM D2665 2 inch Sch 40 -ASTM D1785 11/2 Sch 40 -ASTM D1785 CUNi061P � 1 83 - Page 11 V?n 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 LEGAL DESCRIPTION Property Location SW 1/4 , NE 1/4, Sec. 27 , T Subdivision Plat. Plat of Houlton Certified Survey Map # 030-2061-90-000 30 N R 20 W, Town of St. Joseph Volume , Page # Warranty Deed # q...q ({ 0 011 (before 2007)Volume , Page # Spec house OyesOno Lot lines identifiable ayesC]no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Lot # 1 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 warran deed recorded in Register of Deeds Office. 3 Number of bedrooms IGNATURE OF APPLICANT(S) g /21 / Itl 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) Department of SOIL EVALUATION REPORT #1723 S P - Safety and in accordance with Comm 85, Wis. Adm. Code Page 1 of _3 = Professional Services Schmitt Soil Testing, Inc. Attach complete site plan on paper not less than 8%2 x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and — a I.D. % percent slope, scale or dimensions, north ary"' ?nd location and distance to nearest road. UVI Please pri a " imation. /- 0-2061-90-000 ev —i Date I U Z3 n Personal information you provide ` or ary purposes (Privacy Law, s. 15.0�6 frt) (m)). Property Owner Property Lo i Mondor, Scott M. Govt. Lot '�^�oG SW1/4, NE1/4, S27, T30N, R20W Property Owner's Mailing Address 2040 10th Ave. Lot # Bl�*Iubo. Name or CSM# 1 T OF HOULTON City State Zip Code one Number City Village 1 Town Nearest Road Star 'e WI 5_ 715-248-7702 St.Joseph Church St. New Construction Use( _ Residential Jumber of bedrooms 3 Code derived design flow rate 450 GPD lace -- --- -- r commercial - Describe: Pa rent material Glacial ill (Ofterholt 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". 1�J� � '^n, 9_ ? 4'2' lL— - J-0 i, l �rc �.r�i� W--' X J , /o L a, ,5 looks o ❑ Boring # Boring Pit Ground surface elev _ 98.68 ft. Depth to limiting factor 28 in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consisten Boundary Roots GPD/ft' 'Eff#t 'Eff#2 1 0-8 10yr4/4 none vfsl 2msbk mvfr Cs 2m,lf 0.4 0.8 2 8-28 10yr5/3 none lvfS lcsbk mvfr gw 2m,lf 0.4 0.6 3 28-33 10yr4/4 c2d 10yr6/3 1�,�/$ Ivfs lcsbk mfr gw if 0.4 0.6 4 33-63 7.5yr4/6 _ c2d 10yr6/1 10yr6/8 vfsl Om mfi CS ------ 0.2 0.5 5 63-84 7.5yr5/6 m2d 10yr6/2 10yr6/8 vfsl Om mfi ---- ------ 0.2 0.5 Z 1 1 Boring # ! i Boring Pit Ground surface elev. 99.38 Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz, Cont. Color Texture 1 0-4 10yr4/3 none vfsl 2 4-26 10yr5/3 none Ivfs 3 26-38 7.5yr4/6 c2d 10yr6/3 10j r6J8 vfsl 4 38-72 7.5yr5/6 m2d —r /a /2 sit Depth to limiting factor 26 in. Structure Gr. Sz. Sh. Consistenc Boundary Roots 2msbk mfr gw 2m,lf icsbk mfr gw 1vf lcsbk mfr gw ------ Om mfi ---- ------ ail Application Rate GPD/ft2 'Eff#1 'Eff#2 0.4 0.8 0.4 0.6 0.2 0.6 0.0 0.2 u--t x I - ovv5- ov - ccu mg/L ana ( as >su < iou mg/L Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: �oCST Number Thomas J. Schmitt _��� 227429 kddress Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 9/11/2013 715-760-1978 SBD-8330 (R-07/00) EM Property Owner Mondor, Scott M. Parcel ID # 030-2061-90-M 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 in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 *Eff#1 *Eff#2 1 0-9 10yr4/3 none vfsl 2msbk mfr a 2f 0.4 0.8 2 9-29 10yrS/3 none lvf5 lcsbk mfr gw 1Vf 0.4 0.6 3 29-47 7.5yr5/6 c2d 10yr6/2 10yr6/8 lvfs lcsbk mfr gw 1Vf 0.4 0.6 4 47-75 10yr5/6 m2d 10yr6/2 10yr6/8 sil Om mfi ---- - 0.0 0.2 F-1 Boring Boring # pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fts 'Eff#1 *Eff#2 F-1(� Boring Boring # Pit Ground surface elev. ft. Depth to limiting factor in, I_J Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 *Eff#t I 'Eff#2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BOD5 < 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 (R07/00) Schmitt Soil Testing, Inc. Page 3o 3 ch_ itt _ oil es in Inc. Na e: Sco M M do Thomas e Ric J. Schmitt, t1 St. mond CST 27 29 Ad re : 2 10 h Ave. e. ,VI 54 Houlton, 27 T Croix - I 01 - si Site Address: Desc ip, 53 Cbu . h St., ou WI 5402 L20W ty ho e: 1 - 60- 97 ignat re Legal To nsl ' f 1C r 3 ho ark C o ofWell' p ttomf u ty: St. ose h, en Nor = 3 on ur in EI. 9.2 ' I a I Log -EELE it r Si e E alu tion was co a lot corners- ified at the time the ber, links, tN ieEl conducted. .' R «.. ,.?C _ t .� ,a. 'ud"'.:���< � �. so- s a a: r �x32/ x r St. Croix County Planning and Zoning Monday, February 11, 2008 at 2:43:15 PM Detail Sanitary Information Page 1 of 1 Computer #: 030-2061-90-000 Sub/Plat: Village of Houlton Section: 27 Parcel #: 27.30.20.594 Lot: 1 BIk9 TN/RNG: T30N R20W Municipality: St. Joseph, Town of CSM: 1/4 1/4: SW 1/4 NE 1/4 Owner: Mondor, Scott M. 53 Church Street Houlton, WI 54082 State Permit: 514813 Issued: 12/05/2007 POWTS Dispersal: Non -Pressurized In -ground Permit: Renewal County Permit: 0 Installed: POWTS Detail: Bio Diffuser (11") (PSA) Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Pam Quinn NA Bird, Byron Jr Not determined Signed Off: No needs to aye Byron's signature on the application pro ssed with verbal O by plumber to re w under his name M� Additional Notes Money Owed owner came in last day and paid for renewal - $0.00 keeping permit card in file and don't release until either Byron signs form or until a different plumber applies for change prior to installation of POWTS. Need state form with transfer of plumber, new plot plan & $85 fee for revision. Owner: Mondor, James 53 Church Street Houlton, WI 54082 State Permit: 488018 Issued: 12/05/2005 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 0 Installed: POWTS Detail: Bio Diffuser (11") (PSA) Bedrooms: 3 WI Fund: POWTS Pretreatment: NA n Notes Issuer/Inspector As Built Plumber Kevin Grabau NA Bird, Byron Jr. Not determined Signed Off: No Other Requirements Additional Notes Money Owed Scott M. received property via QC deed in 2007 $85.00 May require revision with additional soil testing due to well being located <50 ft. from current tested area (per Tom Mondor's site visit) Byron was paid 11/22/07 for this permit DECEIVED r nnr17 I wtut-L, ttlerce-W .gcw Safety and Buildings ivlsion County. _ C 201 W. Washington Ave., P.O. Box 7162 / 1�1J I Sanitary Permit Number (to be filled in by Co.) Madison, WI 53707-7162 rce Sanitary Permit Application State Tr; nsactionNumber In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental NIA Project Address (if different than mailing address) unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Commerce. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. I. Application Information - Please Print All Information Property Owner's Name Parcel # S 0 r /SON.DDIZ-- 036, OHO - D -ODU Property Owner's A�d}drr Property Location /M,,ailing () �V 1 Govt. Lot _ Section City, State Zip Code Phone Number�''/,, J;k� J / �� 2 / (J 1O 0 (circle o9) T N; R 2O E Qr W J II. Ty Lot of Building (c eck all that apply) 3 # �or Subdivision Name g - Number of Bedroom 2 Family Dw^-e�llIippn �Ak Gj � C — Block # ❑ Public/Commercial - Describe Us ❑ City of CSM ❑ State Owned - Describe Use ❑ Village of ^ % Number ` —P , r?7 �It Dine L1�"Town of III. Type of Permit: (Check only one box on A. Complete line B if applicable) A' New System ❑ Replacement System❑Trean nent/Holding'ank Replacement Only ❑Other Modification to ExistingSystem (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber la4rmit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner �� 7 f _ l,� S 6 7 IV. p e of POWTS S stem/Com onent/Device: Check all that a 1 3 / ST. (il/ 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) Loa ) retreatment Device (explain) V. Dis ersaVrreatmentArea Information: Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (sf) Dispersal Area Proposed (sf) c System Elevation 90• / S-i D. S 9a0 3 3 VI. Tank Info Capacity in Total # of Manufacturer v a Gallons Gallons Units D New Tanks Existing Tanks c 1 0 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 ga ii -r3i rz-D JZt aaa 5�) 7 7 S- -J(T -76- Pktmber'//s Address (SStreet. Ci , State, Zip Code) VIII Count /De artment Use Only Approved El Disapproved Permit Fee $ G q i 1 Date Issued +�/� Issuing Agent S lure / fit. ❑ Owner Given Reason for Denial J ` 'NER' �!l,► � IX. Conditions of Approval/Reasons for Disapproval _ C 10�C� G�� 1 Septic tank, effluent filter and -�--�2_ dispersal cell must all be serviced /maintained as per management plan provided by plumber. GG G`W� 2. All setback requirements must be maintained as pera licable code/ r ' Attach to complete plans for the system and submit to the County only on paper not less roan a to x t i mcnes in stzc SBD-6398 (R. 01/07) Valid thru 01/09 PLOT PLAN PROJECT Scott Mondor ADDRESS.2040 10th Ave Star nrairie Wi. 54026 1 /4 1 /4S 27 /T 30 N/R 20 W TOWN St. Joseph COUNTY ST. CROIX MPRS Byron Bird Jr. 220527 �;�� DATE 11-30-05 BEDROOM 3 ._ CONVENTIONAL XXXX At rade C NVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 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=90.05 A6' Bio Diffuser with 31.1 ft^2 per chamber 6" Long 34" Im! —Grade at System Elevation < to Hy 35 Access Rd 165' � 1 65 ii Driveway 25' 190, 60' PL �, 95' 3 Bed House &Shed 96' 96' 15' st 6 B2 85' B� 62' 15' 125' 95' 25' Bl 75' 25' 1 80, 165' PL 190, PL PLOT PLAN PROJECT Scott Mondor ADDRESS 2040 10th Ave Star nrairie Wi. 54026 1 /4 1 /4S 27 /T 30 N/R 20 W TOWN St. Joseph COUNTY ST. CROIX MPRS Byron Bird Jr. 220527 4��i DATE 11-30-05 BEDROOM 3 CONVENTIONAL XXXX At,r rade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000gal LIFT TANK SIZE DOSE TANK SIZE _ HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers 30 kk 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=90.05 > 12" of Bio Diffuser with Cove 31.1 ft^2 per chamber 6" 6' Long 34" Elevation < to Hy 35 Access Rd 165' 65 Driveway 25' 190' 60' PL 40' 95' 3 Bed House &Shed 96' 96' 15' t 6 B2 85' B3 62' 15' 125' 95' 25' B1 _-_, 75' 25' 1 80' 165' PL 190' PL f-- i. dance s rm in a=-d vMth! Comn, 85, V. Coc. i Coun n; ed `Eon paps" P.c- iss ,Sze. L. M. on s t an F, Ir4 x I I i in ches -- ver !icaf and horizont irafeience po':nt (B: ,,, d:'rection. aind znsr--*n� sca.�e 0-: cirnenslonS. norlp a-Tal.q. 2nd arld di: tanW WfleaIeSt , rCp�d- Nease print ah, infomaffon. Re d by Zz--SznA-!: intorriatior. you p-mv::de ray -5eused '*, secards- purposes 10�; ma nn)) - Property Location Page t 0-*3 !�£� //%! L'�'! !/G^ I Govit. Lot V4 Jj4 Sd, 2 T J,:q N R,-0 E eo nees Mai--;na Address Lot Block # Z SL,.bd. Name or CSW V, 3 Dhcn S at a zz!:� a M, cit�v Tiliace FX— To mi Neaes; Read n of jiedroorns Code de..—;ved desian fiow rate 7:;oo,_-- plaid: 91'evajon F; apolicable hd v-j -2-iyi &-AJ 01) j m ev. 9&- Depth to iimiting fact.or in. Ground sumce el I Snit Annfination Rate _cTnimam CO: Uf Consistence Boundaii-y Structure Roots GPDf '-Aunsei! Q U S Z. on t. C C- 0 G, S S h. - Eff#I -Eff#2 19 /01 J4 vx- 67 A19 -4 7 -ZTtv) -9 Depth to tactor So7; ADplicat, Rale a n i a Redox Desci-I ption. Temiure I Structure, COrSiisteme Boundary, Roots C-PD&, Un j. SIZZ. --Gior i Gr. S Z. S Z4 IA K 1A vx 3/1Z /i lAaA 1 > Z-�Dji2210 mgL andTS—S *0 < 150 Name se C-jress #Z- = BOOD-. < 30 r'ncf, 2r.-c- T SS < 30 MC--1 CST Number o' Gate Evaluation Conducted Telephone Number Parcel [C Page o, �- Bering oring I p•.•, Ground surface eiev. / 4� Depth to ;imaing facie ir,. Sol Application Rase f-1. erinant + CG+lor j ., ; e R ox Descrir.tor. ( Texture i Stru re I Consistence � Boundary Roots GPDXAS itur?sell { Qu. Sz. Cont. Color Gr. Sz. Sh. s >E2 l i ? Borire _ ? M, Ground surface elev, ia. Depth to limiting factor i(Z. SOiI DiicatiOrt Re ..o; lzon Depth Dominant Color Redox Descrption ( Texture Structure i Consistence, 8oundary 1Roots l G?G/f& i Munseal i Qu. Sz. Cont. .0 i , o?cr l l Gr. Sz. SI,. i 'Ef!fl Ef2 ' ` I Boring l +coring = ?;; Ground surface elev. ft. Depth to limiting factor in. -ort j De* ' Dominant Cow! Redox Desc:^:ptio^ ! Texture ; structure Ccnsisie^ce? 3oundanri Rocs ' GYCi Munsell Qu. Sz. Cont. Color i Gr. Sz. Sh. 'er-#2 I � i l l I ? l ? l , lij 1 t ETtieri m? = 30D5 > 3G < 223 mg1L ar:.d TSS > 3 0 < 15c mgrL ' Ffia cent 42 = SOD, < 33 mgR. and TSS < 30 m3 3 e Department of Commerce is an: equal opportunity service provider and employer. If you need assistance to access services or reed material in an aitemate format, please contact the department at 608-266-3I5I or 17Y 608-264-81/77. sari oe0 Page of coring Borina# raniq facio? 46;) in p;# Ground surface elev. Deplh to Sot Appfica:io:,. Rae I Hofton, Dew', 1, Dorninant Co-lorl Redox Descrin-tion I Texture Structure consistence Boundary Roo-ts, GPDff in. Munselll i u. QSz- Cort. Color Gr. Sz. Sri. -E:: 2ff# -12 Y, k�- V,� 10- 1: V,41 5 1 Bonna Ground surface elev (w Depth to firnOting factor in. 1 C-N, r—f- 12 Horizon Depth Dwrinant Color!, Redox Description -texture I Structure i Consistence i Boundary Roots GPDtf.9 mewmell i Qu. $z. Cont. wfGr G r. S z. Si. -E j boringl: Ground surface elev. R. Depth to limiting factor in. Pit I I 1Z,P r1o."Lon Depth Dominant Color! Redox Descri -e ption Texture istence Boundary' Roots Structure cons' GPDAT 'Ef *2 in MunseN Qu. Sz. Cont. Color i Gr. Sz. Sh. 'Eff- * Effluent #1 = BOD, > 30 �< 220 mg/L and TSS >30 < i50 mgrL ' Effiuerit, #22- = BOD< < 30 mg& and TSS:5 30rng(L I TD DO I I epartmert of Commerce is at. equal or) ^ r1unity service provider and employer. if you need assistance to access services or need meterial in an alternate format- please contact the departm I ent at 608-266-3151 or 17Y 608-264-8177. S3- D43 -1 0,-.Z- WWI, Soil Vest Plot Plan Project Name Scott Mondor Byron ird Jr. Address -i 2040 10th Ave Star Prairie Wi. 54026 CSTk� #220527 Lot 1 Subdivision Blk 9 Date 11/30/1905 CountyST. CROIX 1/4 1/4S27 T 30 N/S20 W TownshipSt. Joseph V-Houlton 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 190, PL ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/q S mok) j)o Mailing Address 26 Lf / /7_, Sty dr�ch,c� Cv4_ S7{0 Zb Property Address 3 C ",c4, (Verification required from Planning & Zoning Department for new construction.) City/State YCk�T(fh 0,,6Parcel Identification Number 3 Ut— �;6 " 6&U LEGAL DESCRIPTION (' S'� 41) Property Location S(i<% %� ,/JE '/4 , Sec. 7 , T O N R 2 W, Town of ��'. � W� Subdivision Plat: V26 Lot # Certified Survey Map # , Volume , Page # Warranty Deed # �� �j� (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 V3 full of sludge. 1/'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 S G A 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) St. Croix County Planning and Zoning M eduesday, December 05, 200' at 11:59:35 AM Detail Sanitary Information Page 1 of 1 Computer #: 030-2061-90-000 Sub/Plat: Village of Houlton Section: 27 Parcel #: 27.30.20.594 Lot: 1 BIk9 TN/RNG: T30N R20W Municipality: St. Joseph, Town of CSM: 1/4 1W SW 1/4 NE 114 Owner: Mondor, James 53 Church Street Houlton, WI 54082 State Permit: 488018 Issued: 12/05/2005 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 0 Installed: POWTS Detail: Bio Diffuser (11") (PSA) Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Motes Issuer/Inspector As Built Kevin Grabau NA Not determined No Plumber Other Requirements Additional Notes Money Owed Bird, Byron Jr. Need state form with transfer of owner & Scott M. received property via QC deed in 2007 $85.00 plumber, new plot plan & $85 fee for May require revision with additional soil testing due renewal/revision. to well being located <50 ft. from current tested area (per Tom Mondor's site visit) Byron was paid 11/22/07 for this permit St. Croix County Planning and Zoning Mondaj,, August 27, 2007 at 3:22:16 PM Detail Sanitary Information Page 1 of l Computer #: 030-2061-90-000 Sub/Plat: Village of Houlton Section: 27 Parcel #: 27.30.20.594 Lot: 1 BIk9 TN/RNG: T30N R20W Municipality: St. Joseph, Town of CSM: 1/4 1/4: SW 1/4 NE 1/4 Owner: Mondor, James 53 Church Street Houlton, WI 54082 State Permit: 488018 Issued: 12/05/2005 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 0 Installed: POWTS Detail: Bio Diffuser (11") (PSA) Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Requirements Additional Notes Money Owed Kevin Grabau NA Bird, Byron Jr. Byron hasn't been paid yet for this permit Scott M. received property via QC deed in 2007 $0.00 Not determined Signed Off: No and is holding the permit card until owner pays up - PLEASE require the permit card be returned before any change of plumber!! `'i/ ✓ UZ J ------- - - - - -- � j; - --- a �- a oCcc,► Land Information 6 Planning 715-386-4674 RealProperty 7,-386-4677 Recycling 715-386-4675 PZ@CO. SAINT- ROIX.WI.US FAX MEMO DATE: To: FAX NUMBER: FROM: FAX NUMBER: PHONE NUMBER: Post-ita Fax Note 7671 Date To U i �- 1` 1 G►1 Q ✓ Frorr Co./Dept. Co Phone # _ Zy r" _ . 7 Iv / ^ Phonj Fax #Uc� I _ y39 _ -7 Fax # 715-386-4686 Z % 16-) (pages 10- NUMBER OF PAGES, INCLUDING COVER SHEET: jq RE: -',...t t ST CRO1X COUNTY GOVERNMENT CENTER 1 101 CARM,ICMAEI_ ROAD. HUDSON, Wi 54016 715386-4686 FAX WWty CO SAfNTC ROIX WI US Vet S an ui ings ivision 201 Was P.O. Box 7162 County Nvisconsin Z. n ire., ison, 9707 - 7462 it 5 L '14Department nitaryermit Number (to be filled in by Co.) g)2 SI QUO 9 of Commerce Sanitary Permit Applicatio s1. CROIX COUPto Pit°°I.D.. Number In accord with Comm 83.21, Wis. Adm. Code, personal information P oject Address (if different than mailing address) may be used for secondary purposes Privacy Law, s15.04(1)(in) --I' n (7- � t s ` I. Application Information - Please Print All Information Property Owner's Name Sw *- 2 G`� t^Property Parcel # rot # Block # �� *A_dre�;_. Owner's Property ocation / �` � +� /4, /4, Section Phone Number City, State Zip Code r T �L"J N R,FEcle II. Type of Building (check all that apply) Subdivision Name CSM Number )4-4 or 2 Family Dwelling - umber of Bedrooms ❑ Public/Commercial - Describ Use—r— ❑Ci Township of C e ❑ State Owned - Describe Use `• flag, D III. Type of Permit: (Check only o box on line A. Complete line B if plicable) -Zp�p - 0 - C&o A. j 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 32 Non -Pressurized In -Ground ❑ Mound > 24 in. of sui ble soil Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In -Ground ❑ Holdin Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter aching Chamber rip Line ❑ Gravel -less Pipe ❑ Oth explain) V. Dis ersaVTreatment Area In ormation: Design Flow (gpd) Design Soil Application Rate(gpdso is rsal Area Required (sf) Dispersal kea Proposed �stemElevgtion yO /.$ — , J VI. Tank Info Capacity in Total NuPhber Manufacturer Prefab to Steel Fiber Plastic Gallons Gallons of nits Concrete Constructed Glass New Existing / Tanks Tanks Y S tic Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for insta tion of the POWTS shown on the attached plans. Plumber' Name (Print) / Plum gnature MP/M S Number Business Phone Number /7 -z ✓� Plu is Address (Street, City, State, Zip C r � - VIII. Countv/De artment Use Onl SanitaryTermit Fee includes Groundwater Date Issued Issui g Agent Signa a (No Stamps) ❑ Approved Dived Surcharge Fee) 77�.� E- ❑ enReas for Denial IX. Conditions Apr SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. aim 1. Atracn compere pians k,o me —JUH,c u...yi .o. r,.I....... SBD-6398 (R. 01 /03) ��� bI- UKOIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address1 10A� « Property Address (Verification required from Planning & "Zoning Department for new construction.) City/State LEGAL DESCRIPTION Property Location '/4 , Subdivision Certified Survey Map # (. s9�) Parcel Identification Number V� _'/4 ,Sec. 02 T N R aVW, Town of 65 Volume -_ , Page # Lot # Warranty Deed # % oZ , Volume Page # d C� Spec house yesC�' Lot lines identifiable <!�Fp 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. 08105) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of �{ ` i'}W "1/`2 SYSTEM SPECIFICATIONS FILE INFORMATION C7 V M L Owner O.z c 0 �g Permit # �1. DESIGN PARAMETERS vNumber of Bedrooms ❑ NA Number of Public Facility Units RNA Estimated flow (average) 5 G, gal/day Design flow (peak), (Estimated x 1.5) gal/day Soil Application Rate gal/day/ftZ Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) <_30 mg/L Biochemical Oxygen Demand (BODS) <_220 mg/L ❑ NA Total Suspended Solids (TSS) <_150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODS) :530 mg/L Total Suspended Solids (TSS) 530 mg/L ❑ NA Fecal Coliform (geometric mean) :5104 cfu/100m1 Maximum Effluent Particle Size YB in dia. ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Septic Tank Capacity e 1 gal ❑ NA Septic Tank Manufacturer ❑ NA Effluent Filter Manufacturer - ❑ NA Effluent Filter Model z -`., ❑ NA Pump Tank Capacity gal ❑ NA Pump Tank Manufacturer ❑ NA Pump Manufacturer ❑ NA Pump Model ❑ NA Pretreatment Unit [3-NA ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other: Dispersal Cell(s) ❑ NA _91-n-Ground (gravity) ❑ In -Ground (pressurized) ❑ At -Grade ❑ Mound ❑ Drip -Line ❑ Other: Other: ❑ NA Other: ❑ NA Other: ❑ NA MAIN I tNANGt bGrltuut.t Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) /K year(s) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ Y ear(s)(s) (Maximum 3 years) ❑ NA ❑month(s) ❑ NA Clean effluent filter At least once every: .-E� Y (s) NA Ins p p, pump controls &alarm Inspect pump, At least once every: ❑ year(s) ❑ month ) CENA Flush laterals and pressure test At least once every: ❑ year(s) Other: every: At least once eve ❑ month(s) ❑ year(s) © NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third %) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 1512 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) . .. of. START UP AND OPERATION Page _ For new construction, prior to use of the POWTS check treatment lank(§)`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: 'l 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. ❑ 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 Name Phone 6 C POWTS MAINTAINER Name Phone 2 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name 0Z- 49 lel� Name G VIC Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. HLOCA',19. ' STREET. Lt4 z. H/- ocff, 3. ,rat 3, 27 Page 1 of 1 Pam Quinn From: Carrie Stoltz Sent: Wednesday, December 19, 2007 3:21 PM To: Kevin Grabau; Jennifer Shillcox Subject: FW: Scott Mondor Electric -----Original Message ----- From: Dwight Farnham [mailto:dwight.farnham@sbcglobal.net] Sent: Wednesday, December 19, 2007 3:12 PM To: Carrie Stoltz Subject: Re: Scott Mondor Electric Carrie Stoltz wrote: Hi Dwight, do you remember exactly what you told Scott Mondor he could store in his garage? When I issued the permit I always ask for what purpose will the building be used. Mr. Mondor told me it would be a garage for his trucks. Later he inquired about living quarters in the building and I told him he would have to have a well and septic system and that the structure would have to be compliant with all the codes of a dwelling and get a new building permit. Some time later he told me that he didn't want to spend all that money and would leave the structure a garage. The building inspector as told me that he is finishing the portion of the building that was to be living quarters, although he is not living in the building now. Also he stores materials for his electrical business in the building as well as the trucks. One of the adjacent land owners told me to observe the property in the early morning and see the loading of trucks with materials, tools and equipment. He is running a full fledged buiiness from this location despite what he tells you. Dwight Farnham Zoning Administrator/Code Compliance Town of St. Joseph (715)549-5203 2/9/2010