HomeMy WebLinkAbout030-2153-30-000 (2)Department of Commerce
SafetyWscoPRIVATE SEWAGE SYSTEM
Safely and Budding Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Lew. s 15 04 (1)(m)]
Permit wrdd.e. Kj.--
Mark & Laura Hisle
'ST SM Elev
TOWN OF SAINT JOSEPH
Description
TANK SETBACK INFORMATION
TANK TO P!L I WELL I BLDG. I vent to Av Intake RC)An
samm
r:ram
, WW2
PUMP/SIPHON INFORMATION
rer
G D� L D
Demand
mber PE 51
NTDHL[ft
GPM
q2 Spa t
2561 �d
Fnclion Loss
11
System Head
TDH Ft
y.s2
y.55 1
W, ,
Forcemain
Length
DIa.
Dist to Wan
�5D'
SOIL ABSORPTION
SYSTEM
BEOITRENCH
DIMENSIONS
AdOh
Length
No. Of Trenches
%3•s'
SETBACK
INFORMATION
SYSTEM TO
P/L
BLDG
WELL
Type Of System
Mond
I I '
S l
12a'
DISTRIBUTION SYSTEM
ELEVATION DATA
STATION
BS
HI
FS
ELEV.
Benchmark
�I
IN I
)co
Alt. 8M
Bldg. Sewer
c I�
St/HI Inlet
SIIHI Outlet
Dt Inlet
DI Bottom
HeaderlMan.
100,51
Dist. Pipe
Bot. System
III JJ
Final Grade
1 Cover
2CC'�D
I
l_oo4a,�
J 1
cIf. C7
SE (,,,rp� 6 ura
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9)
TI �
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SIO
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n,t1' n
tUIPtIT
No Pits
Inside a. Li epth
LEACHIN
CHAM O
Manufacturer
Mod I Ner
Length 3
Pipes) I -,I I x H040 Size x Hole
Die ,'S Length %3 S p10 Spacing 5J32
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems ON
Dsplh Over Depth Over De th of
Bed/Trench Center Sedrrrench Edges To P i Seedetl/Sodd
paod
OM ENTS: - (�Gude c e discrepencies, persons present, etc.) Inspection 91:"2
lop
4 2
1.) Alt BM Description =
2.) Bldg sewer length = OL
- amount of cover =
3))-T IL clleu Su�P
to Air intake
Yes Tl No Yes —1 No
Inspection 02:
SO4,1cr boxes ov.r -6-rt ups
Pla revision Required? 4j Yes _2z No
Use other side for additional information. I2a e25igna rp
SBD-6710(R397ra 1 Ce�rt —
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Canditkno BYSfMOWNER:
3) A�t C&Ak `i84
Septic tank, effluent filter and dispersal cell
.01 w
must be serviced / maintained as per
management
P �AAL� r--a LOS4
plan provided by plumber,
1�wt1,n -
I setback requirements must be maintained
ic LI,d:fx, be
♦er.� � �e.w .� a.r rr - �. -
SBD-6399 (R, 03111) fee_.
WisLonsin Department of Safety and Professional Services yti�Q� �hT,
Division of Industry Services
4822 Madison Yards Way
PO Box 7302 s
} 9
Madison. WI 53707
November 8, 2022
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 2024-11-8
Plan Review: PWTS-112202772-C
Kim Oconnell
504 3rd Ave E
Osceola, WI
SITE:
Hisle
472 149" Ave
Town of St Joseph
St Croix County
NW A NE'/. S20- T30N — R19W
FOR:
Phone: 608-266-2112
Web: hlto:' sm wi.¢oc
Email: dtipa.u'isc�+loin egr+r
Tony Evers, Governor
Dan Hereth, Secretary
Conditionally
APPROVED
DEPT. OF SAFETY AND PROFESSIONAL
SERVICES
DIVISION OF INDUSTRY SERVICES
SEE CORRESPONDENCE
Description:3 bedroom-4S0 GPD mound-33"
to limiting factor- Effluent Filter - Mound Component Manual — Ver. 2.1, SHD-
Maintenance required. 10691-P (S/22-5/27)
Pressure Distribution Component Manual — Ver.
2.1 (May 2022-2027)
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative
Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be
constructed and located in accordance with the enclosed approved plans and with any component manual(s)
referenced above. 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
• The site shall be properly prepared prior to plowing. Any grasses longer than 6" shall be cut short and
removed. To avoid matting, any leaves or loose organic matter shall be raked up and removed. Cut trees
and shrubs flush to the ground and leave stumps. Avoid operating equipment on the
Mound site. If necessary, use only tracked equipment, during dry conditions, with minimal passes, to avoid
compaction.
• Components and soil removed from an existing drain field shall be properly disposed of so that there is no
risk to public or environmental health.
• A sanitary permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 14S.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made
with the designated county official in accordance with the provisions of Sec. 14S.20(2)(d), Wis.
state.
• A state approved effluent filter is required. Maintenance information must be given to the owner of the tank
explaining that periodic cleaning of the filter is required.
• A copy of the a roved 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
The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a
copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is
operated and maintained in accordance with this chapter and the approved management plan under s. SPS
383.S4(1).
• In the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard, the property owner must follow the contingency plan as described in the approved plans.
The owner is responsible for submitting a maintenance verification report acceptable to the county for
maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s)
utilized in the POWTS.
In granting this approval the Division of Industry Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the
address on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and
any others who are responsible for the installation, operation or maintenance of the POWTS.
Sincerely,
Joshua Rowley
POWTS Plan Reviewer, Division of Industry Services
(71S)634-5124
Joshua.rowleyC@wisconsin eov
APPLICATION FOR REVIEW
Complete all pages-
S - NOTE: Personal in(nmwtion you provide may be used for secondary purposes
'•+i,;�a;,u;!% (Privacy Laws. 15.04(1 xm), Stats.)
U Plans to be E-filed. Provide SharePoint User name below:
Private Onsite
Wastewater Treatment
Systems
Division of Industry Services
For plan status, check our website at
Email technical code questions to
Several counties have been delegated certain authority to review plans in lieu of Division of Industry services. For a current list of those
counties and their designation check our webstte at
1. Project 111110 na ion - FRI In all lute. Information.
Project/Site Name:
i
Location. Number iL Street of projed (I L indicated nearest road)
rZ
Legal Description /-
Counly
❑ City ❑ Village ® Town of
2. After plans are reviewed, pleap: (cheek al Otat apply)
❑ Call customer 1, 2 (circle number)'
❑ Requesting party will pick up
Mail plans to customer 1, 2 (circle number)'
`Refers 10 customer number from below.
Continuation of assignment to a reviewer.
Transaction ID:
Previous Related Trans. ID:
Estimated Completion Date:
Aeslgned Reviewer -
Assigned Office:
Mail to your office of choice below:
La Crosse, Greeri Bay
NOTE: We reserve the right to rs-distribute plans to another office it
needed to reasonably balance turnaround times. Check
for next available review date
3. Compieea the tpMowing designer/ownerlrequesting iMormab"L Ullfte the check boxes when designer. owner or requesting party is the same to
avoid repeating Information.
Fes, jt on (Cut�tomer 1) DSPS Other Please Specify Below (Customer 21 -- DSPS
(afi fait Nthrrl Custom Number First Name L�t 14am_e Customer Number
/SL - — —
Address� Adarese
9) f S to z;p•4 9 digits))
Phone
� lifle
kanr cod phone, P Wtrrrrbar all address Celt phone
) E-mail address � l ��� (arse code)
Check if appocable
❑ �� Check if applicable of specify relationship
ip
Information and Plan Submittal Chockltsts. To Owner complete tOther he retrar►sh
request alactrnrtic plan review complete the appropriate application ttxm and e-mail it, Wong with your registered SharePoint usemame to - ' - - ff plants are being submitted via paper, they
will be assigned to a reviewer after receipt at a DSPS Aae. Submittal cheddhft can be found in each applicable component manual
appearing on the POWTS program page under Pub&z&:,ns
Holmen/Onalaska Area DSPS en Bay DSPS
2850 Midwest Dr Ste 104 Green
San Luis Place
Onalaska, WI 54fi50 2331 Green Bay, WI 54304
Fax;
Fa5 9334 920492-Wi
u 6785 933p Fax 920-492-5604
Email:
Email:
(Make Checks Payable to: Division of industry Services OR
❑ Check box to invoice designer and sigh below TOTAL AMOUNT DUE sa�G
DoSlgner Signature met"' Code 7833
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MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name:
Hide Conditionally
Owners Name:
Mark & Laura Hisle DEPT. OF SAFETY AND PROFE SIONAL
SERVICES
Owners Address:
15465 5th ST NE DIVISION OF INDUSTRY SERVICES
Ham Lake MN 55304
or
SEE CORRESPONDENCE
Legal Description,
NW-NE-sec20 T30N-R19W
Township:
St Joseph
County:
St Croix
Subdivision Name:
Pioneer Ridge Counta Plat
Lot Number:
30 Block Number:
Parcel I.D. Number.
030-2153-30-000
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 Pump curve and specifications
Page 8 Plot Plan
Page 10 ATT soil evauation
Designer: Kim A Ocon ell License Number.
Date: 11/03/22 Phone Number:
Signature: -
224263
715-381-7917
Designed Pursuant to the
Mound Component Manual for POWTS Version 2.0 SBD-10691-P (N. 01101, R. 11112), and both
SSVVMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01181) and
Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01101, R. 10/12)
Version 7.0 (R. 11/12)
Page 1 of 9
Mound and Pressure Distribution Component Design
Design Worksheet
(R or C)
Site Information
Residential or Commercial Design
Estimated Wastewater Flow (gpd)
Peaking Factor (e.g. 1_5 = 150%)
Design Flow (gpd)
Site Slope (%)
Contour Line Elevation (ft)
Depth to Limiting Factor (in)
In -situ Soil Application Rate (gpd/ftz)
R1
300.001
1.501
450.00
9.00
99.00
33.00
0.60
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)
(C or E)
Pressure
E
Disrlbution Information
Center or End Manifold
Lateral Spacing (ft)
Number of Laterals
Orifice Diameter (in)
Estimated Orifice Spacing (ft) _
Forcemain Diameter (in)
Forcemain Length (ft)
Pump Tank Elevation (ft)
3.00
2
0.156
3.50
2.00
150.00
84.50
4.55 System Head (ft) x 1.3
14.83 Vertical Lift (ft)
/D 1.88 Friction Loss (ft)
0.00 In -line Filter Loss (ft)
21.26 Total Dynamic Head (ft)
Lateral
Diameter Selection
in. dia.
options
choice
0.75
1.00
1.25
1.50
x
x
2.00
x
3.00
x
Treatment Tank Information
1000.001 Septic Tank Capacity (gal)
Wieser IManufacturer
Note Sand fill (D) calculations assume a
Table 383-44-3 in -situ soil treatment for
fecal coliform of <= 36 inches.
6.00 Cell Width (ft)
Are the laterals the highest point
in the distribution Y
network? Enter Y or N
If N above, enter the elevation ft
of the highest point.
10.23 ft2/orifice
Does the forcemain drain back? Y
Enter Y or N
24.47
Forcemain Drainback (gal)
67.44
5x Vold Volume (gal)
91.91
Minimum Dose Volume (gal)
23.69
System Demand (gpm)
Manifold
Diameter Selection
in. dia.
options
choice
1.25
x
1,50
x
x
2.00
3.00
Gallont>sllnch Calculator (optional)
1000.00 Total Tank Capacity (gal)
36.00 Total Working Liquid Depth (in)
27.78 gal/in (enter result in cell B49)
Dose Tank Information Effluent Fitter Information
600.001 Dose Tank Capacity (gal) lPolylok Filter Manufacturer
16,76Dose Tank Volume (gal/in) PL-525 Filter Model Number
Wieser IManufacturer
Project: Hisle Page 2 of 9
Mound Plan and Cross Section Views
1/10
�'—� 1. n �
:. r
..: ., s.,.l.f.l.l.r.r.r.l.: •r•!•l ., . ..'-y:.:: ��: ••J•:+ :':; ;:f :: ..
l: �•:J.l.�r•hr.r•!•l.l.Jtil. f. a J.I.J.: -:.. .. :.r.r•: .r•r !- '
:.'�. •••� ••••
• f,�. i~i~�'�•� i f!i-: M:S d :i�i+i:i:r�i: �: r: i:: •' ��itit�i~i 1�i�!
�: ':'
•.l•J•/•r•J•f•h!•!•!•I•r•r•J•!•J•r•J•!•!•r.; .J•!•J•: ...r•r.l.,.: -: •:
1 B
Mound Component Dimensions
A 6.00 ft EEmft
in
B 75.00 ft Fin
D 6.00 in G
450.00 (ft) Dispersal Cell Area
6.00 (gpd/ft) Linear Loading Rate
HA4.23
ft K 7.69 ft
Ift L 90.37 ft
Jft W 19.81 ft
1168-66 (ft) Basal Area Available
7.50 (ft) 1110 B Obs, Pipe Placement
Mound Cross Section View
Aggregate Dispersal Area
Finished Grade 101.29 (ft)
F
99.50 (ft) --I,.
Dis rsa ell -=
Elevation
M
I JH
100.00 (ft) Lateral
I Ceu
Invert
[ -AX
,-j .
i_�`S?y -• - 99.00 (ft) Contour Elevation
9.0 % Site Slope
Geotext le Fabric Cover
Shading Key _$ T Dispersal Cell See lateral details on
10 - Topsoil Cap a 1.5 ft Page 4 for number. size,
o and spacing of laterals.
2❑ Subsoil Cap 1...y.y _ Laterals are equally
ASTM C33 Sand from the
0. ft ''` T1 lateral oed
® Tilled Layer c 't'- ~' distribution Cell's
r•r...: • Aggregate , ...,.,:..,.,.y. ;,.`......
:.;.., r :.r•: •!•l;:. `r-r•r•_• centerline in the
A _� distribution cell (AxB).
Project: Hisle Page 3 of 9
Project:
End Connection Lateral Layout Diagram
aterals c#mewed overt the A& B dimension 40= Turn-upv&Yballvahreorclesnoutplug
P
AN laterals we identical 1.4- X -.-+I Holes drilled on the bottom or the lateral 5
equally spaced
Force man connection via t" of Cr4LS to manitOld at -ar1q DO"
Laterals Morcemain Sch 40 PVC per SPS Te"e 364.30-6
Number of Laterals
2
Lateral Diameter
1.50
in
Lateral Length (P)
73.50
ft
Lateral Spacing (S)
3.00
ft
Lateral Flow Rate
11.85
gpm
System Flow Rate
23.69
gpm
Total Dynamic Head
21.26
ft
Orifice Diameter
Orifice Spacing (X)
Orifices per Lateral
Orifice Density
Manifold Length
Manifold Diameter
Forcemain Velocity
r�
0 156 in
3.50 ft
22
10.23 fly/orifice
3.00 ft
1.50 in
2.42 ft/sec
Dose Tank Information Locking cover with warning
label and locking device and
n sealed watertight
Electncai as per NEC 300 and -♦ I I 11��
SPS 315.300 WAC
Tank component is property vented
Wieser
Capacityl
600.00
Volume
1 16.76
Dimension
Inches
Gallons
A
19.32
323.73
8
3.00
50.213
C
5.48
91.91
D
8.00
134.08
Total
35-801
600.00
Alarm Manuafacturer JSJE Rhombus - Tank Alert
Alarm Model Number 1101-01H
Pump Manufacturer JGoulds
Pump Model Number I PE 51
Pump Must Deliver 23.69 gpm at 21,26 ftTDH
Hisle
4 in. min_
z,
E-- Alternate outlet
location
Forcemain diameter
=3 2 in.
Weep hole or anti -
siphon device
Pump oft elevation (ft)
85.17
Dose tank elevation (ft)
84.5(
Now Switches
containing mercury
may not be used in
this system.
Page 4 of 9
Mound System Maintenance and Operation Specifications
Service Provider's Name Phone
POWTS Regulator's Name St Croix Coun Zonin 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 ft2 Maximum FOG 30 mg/L
Type of Wastewater I Domestic Maximum Fecal Coliform >10E4 cfu/100 mL
Septic and Pump Tank
Effluent Filter
Pump and Controls
Alarm
Pressure System
Mound
Other
Service Frequency
Inspect and/or service once eve 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 1.5 years
Ins ect for ponding and seepage once every 3 ears
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 Tum-up Detail
Finished f
a
........
Grade1
Threaded Cleanout
6-8" Diameter Lawn
Sprinkler Valve Box Plug or Ball Valve
Distribution
Long Sweep 90 or Two
45 Degree Bends Same
Diameter as Lateral
Project, Hisle Page 5 of 9
Mound System Management Plan
Pursuant to SIPS 383.S4, Me. 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 [St3D-1D591-P (N.01/01, R. 11112), SSWMP PublicAtlon 9.6 (01/81), and Pressure Distribution Component Manual Ver_ 2 0 SBD-
10706-P IN. 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 nsers 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 opedvys greater than lHnches 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, Slats. 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 fitter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions
are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the fitter is equipped with an alarm, the
filter shall be serviced if the alarm is activated continuously. Intermittent fitter 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 t>e inspected and serviced as necessary
Mound and Pressure Distribution System
No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be
seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for
vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the
mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October -February) dictate that the
mound be heavily mulched as protection from freezing.
Influent quality into the mound system may not exceed 220 mg/l- BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30
mg/L BOO,, 30 mg/L TSS. 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow
specified in the permit for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be
flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test
when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution
within the dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding Ponding levels shall be reported to the owner, and any
levels above 6 inches considered as an impending hydraulic failure requinng additional, more frequent monitoring
Continency. 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: Hisle Page 6 of 9
Wastewater
M&TM FW
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` *sconsfnIL SOEVALUATION REPORT fR1437
Pape 1 of 3
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Aftech oomphM sw plan on paper not wm own ax x 11 In County St. CID&
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Gdden Her W Capiw, LLC
DEC 13 2006
G LaL�
Nw1K 114, S20. T30N, R1gw
Prapaly Owmft MON Address
149M BMkW" Road
5T. CROIX COUNTY
Ld f1 MD& 0
30 1
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k
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and Area is auitabie for a orr�urrd MMgffm Sysbm elewrion is 90.W booed oQ conlaw Ina eraabllt' st
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Tfromaa J. SchmiN 227429
Address Sdmnitt Soo Tastkr0, kw- Deb Ewkotion Conducisd Tebowne rkanim
1695 72nd Street Mew Rkknmrd, WI SAIM 7127IR006 715-247-2941
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The Dcpwtoad of Coswoersa is = egad opporbmky so vim p[ovi&w end awployw. 1f you good awostaoae to mo =u sa viom or
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schulkt Son Torun %C. Timm Gomm lirrtCapital LLC
JUb J Sdwdfl, G9T 227429 Addaw 1440 Am& St. N
1595 72nd SL atp, Sta1q z%x St. Pd. MN, 55106
New Rk mod. WL 54017
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BAr
ST. C Ro NTY SANITARY SYSTEM File #;
Office use
OWNERSHIP/ADDRESS FORM -w1
Community Development Department will utilize this information to provide the property owner with
information regarding operation and maintenance of your new or replacement sanitary system! This
information will be provided as part of our ongoing efforts to protect public health, your well, groundwater,
surface water, property values, and county resources. Once approved, this completed form and educational
information will be sent to you by email.
OWNER/BUYER INFORMATION
Owner/Buyer Mark & Laura Hilse
Mailing Address 15465 5th Street NE
City/State/Zip Ham Lake, MN 55304
Phone Number (required) 612-816-0806
Email Address (required)hilse comcast.net
Parcel Identification Number 030-2153-30-000
(found on the property tax bill)
NEW SYSTEM: LEGAL DESCRIPTION
Property Location NW ,/, NE 1A Sec 20 T 30 N R 19 W, Town of St. Joseph Town Ship
Subdivision Plat: Pioneer Ridge , Lot # 30
Certified Survey Map # , Volume_ , Page #
Warranty Deed # (before 2006)Volume , Page #
Number of bedrooms 3 Spec house O yes ■ no Lot lines identifiable ■ yes 0 no
New Property Address
to Initials)
r
of
OFRCE USE ONL7,�
address required from Community Development Department for
GO-S
This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications.
New System: Include with this form 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.
Community Development Department — Land Use Division
71 S-386-4680 St. Croix County Government Center 715-24S-4250 Fax
cdd@sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.gov
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LOT 3:
La
Nvisconsin SOIL EVALUATION REPORT
Department of Commerce in accordance Comm 85, Wis. Adm. Code
Division of Safety and Buildings
Attach complete site plan on paper not less than 8'h x 11 in ins n tist
County
include, but not limited to: vertical and horizontal reference point ), di nd ParOoF {
percent slope, scale or dimensions, north arrow, and location and d nos t arefLMbd. -0
3O
Please prir ,
Personal information you prov de may be L sect for}arlwnvacy aw
s (1) (m))
Property Owner Property Location
O'1437
Page 1 of 3
Schmitt Soil Testing, Inc.
St. Croix
—W-w�
Golden Harvest Capital, LLC DEC 1 4 Mb Gout. Lot NW114 E7/4, S20, T30N, R19W
Property Ownees Mailing Address Lot i I Block 0 1 Subd. Name or CSM#
14906 Blakeney Road ST. CROIX COUNTY 30 Pioneer Ridge
City Stalls C2gq Phom Numhor City ! Village r-] Town Nearest Road
Eden Prairie NIN j 55347 (612)202-3234 St Joseph 1 50Th St.
New Construction (° . Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement Public or commercial - Describe'
Parent material Pitted glacial drift _ Flood plain elevation, if appkMft na tl.
General comments
and recommendations: Area is suitable for a mound sy2tgm. System elevation is 99.50' based off contour Nine esta!)NsW at
99.0'. Slope is 9%. Contour line deflects 3from straight in80"
Boring #
Boring Pit Ground surface elev. 99.11 ft.
Depth to
limiting factor 40 ✓ in.
Application Rate
Horizon � Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr_ Sz. Sh.
Consists Boundary
Roots
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Ph Ground surface elev. 99.18 It Depth to limiting factor 108+ In. Soil Application Rale
Horizon
Depth
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Dominant Color Redox Description
Munsell Qu. Sz. Cont. Color
Textum
Structure
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Consists
Boundary
Roots
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+E1111112
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---
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' Effluent #1 = SOD? 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature: �r CST Number
Thomas J. Sehmiri _ , 2-27429
Address Schmitt Soil Testing, inc. Date Evaluation Conducted Telephone Number
1595 72nd Street New Richmond, Wl 54017 7/27/2006 715-247-2941
sail-►ssu (1lu71W)
Ptope1ty Owner Goklen Harvest Capital, LLC Parcel ID M 30 Page _ _ Z_ _of 3
Fil Boring # ❑ Boring .f
Pit Ground surface eiev. %.58 ft. Depth to limiting factor 45+ in. Soil Application Rate
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
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3
4 Boring J
]Boring # Pit Ground surface elev. 99.78 ft. Depth to fimding factor 33 in Application Rate
Horizon ''I Depth
in.
Dominant Color Redox Description
Munsell Qu. Sz. Cont Color
Texture
Structure Consistence
Gr. Sz. Sh.
Roots
Gpone
•E901
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Boring # 11 BOAV
El Pk Ground surface ekw. 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
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•EfW1
•E11112
Effluent #1 = BOD5> 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 TI Y 608-264-8777.
Sao-a330 (R 07M)
SdirtWt Sall Trs[xig, Inc.
Page .3" of 3
Conducted by: Conducted For.
Schmitt Soil Testing Inc. Name: Golden Harvest Capital, LLC
TbDums J Schmitt, CST 227429 Address 1440 Arcade St. N
1595 72nd St City, State, Zap: St. Paul, MN. 55106
New Richmond, WI.54017
Phone: 715-247-2941 _ Subd.Name: Pioneer Ridge -
sbMU.Q ���..a.,( Lot No.: —?0
DM 7 t2 Legai Dion: 12 eeOM NE1/4 S20 T30N R19W
M Backhoe Pit Township, Coungr. St. Joseph, St. Croix
Aq Beach Mark EL 100.W Top of 2" PVC Pape.
U A>bunde Beach Mark EL . 7.j Top of 2" pvc pipe
Slope= 2 A Conrour Line Contour Line Length,Ad
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W
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r �
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42
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RECEIVED
Nov 15 2022
8T. C6m coUNW C00
.�M.60FtF.
0 10
uo
vamcu carrMX MTW: MA%M
mDPIMPMDP. -
4n &M7M AVEMM
1MTTSTOCK BUILDERS
LOT 30, PIONEER RIDGE �•� �• ^^�
MWlf S[C $ iJPI �HY.IUYM a n J[[�� n. pqR CDUMA. WQCONAI ~. �� Yy,r��r ti ~���
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