HomeMy WebLinkAbout032-2005-40-000Wisconsin Department of Commerce
Safety and Building Division
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law. s.1 5.04 (1)(m)]
Kirk & Mary Stueve
BM
TANK INFORMATION
TOWN OF SOMERSET
TYPE
MANLIFACT
CAPACITY
Septic
Dosing
+1
A;79 ?Ion
To—lding
TANK SETBACK INFORMATION
TANK TO
PiL
WELL
BLDG
Vent to Air Intake
ROAD
Septic
-7
Dosing
Aeration
Holding
SOIL ABSORPTION SYSTEM
BEDfTRENCH Width
DIMENSIONS
SETBACK SYSTEM TO
INFORMATION
T Of S
Ce yste�,,
in f �
DISTRIBUTION SYSTEM
DG
TION DATA
btdg Sewe-r—
St/Ht Outlet
MW
NNAM
"Allh,
WAS
2=
9
MMEWAN
UV
Header/Man.
Bot. System
LEACHING
CHAMBER OR
UNIT
4 41 ':::�
Dia
HeaderiMacifold
IDistribution
x Hole Size
Hole
Air Intake!::]
11-ength
Pipe(s)
��
Dia
Length Dia Spacmg__
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Svstems Oniv
Depth Over
Depth Over --,,w
, I I
n Yepth of
teeded/Sodd;
lo�!�
BedrTrench Center
Bed�7rench Edges I
/
To
I "i I
-E
?
Yes No
Yes No
COMMENTS: (Include code discrepencies. persons present, etc.) Inspection #1, Inspection #2
Location: No Address Available
vc&�I. 04\ 01�
1.) Alt BM Description V;Mej
a
2.) Bldg sewer length - (/201,
AtB
- amount of cover = ;P VC7" ; f� ii
�Iow
Plan revision Required? Yes No � //
Use other side for additional information. / ��
Date W -----
SBD-6710 (R 3197) Insepctor's Signature Cen. No.
E771 �10
ST CROIX
Safety and Buildings Division
06 Z02
20 W. Washington Ave., P.O. Box 7162
Madison, Wl
Sanitary Permit Number (to be filled in by Co.)
WN
53707-7162
LS*iftd64i�i�pficafion V--'-'.T'O[l
Number
In accordance with SPS 383.21(2), Wis. AduL Code, submission of this formi to the appropriate unit
is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS we submitted to
Project Address (if different than romil; address)
the Department of Safety and Professional Samos. Pawns] information you provide may be used for secondary
--6
Purposes in accordance with the Privacy Law, s. 15.04(l Xm), Susts.
C)
1. Application Informadon
- Please Print AD Information
Property Owner's Nam
Parcel 0
KIRK AND MARY STUEVE
032-2005-40-000
Property Owner's Mailing Address
Property Location
1708 85TH AVE
Govt Lot
SE SW Section 1
City, State
zip Code
Phone Number
NEW RICHMOND WI 7
54017
(circle one)
T 30 N; R ia E or VY"
11. Type of Building (check &H that apply)
Lot #
I or 2 Family Dwelling - Number of Bodnooms 2
Subdivision Name
�avc*-e
Block
El Public/Comm=ial - Describe Use
11 City Of
0 SUM Owned - Describe Use
11 Village Of
CSM Number
91 Town Of S"nerset VA
111. Type of Permit: (Check only oii-e box on llne;k. (26mplete Use B if appillcable)
A.
0 New System
Ct�Rep�i
13 Trealinesit4toldnig, Tank RcliLsoemicatOnly
C1 Other Moifification to ftating System, (explain)
B.
0 Permit Renewal
0 Permit Revision
D Change of Plumber
ruit Transfer to New
Tollwpwem
lie Previous Permit Number and Doe Issued
Before Expiration
net
IV. 1A*
of POWTS Systeria/ComponenVI)evice: (Check all that apply)
0 Pressurized ln-r� D At -Grade C1 Mound > 24 in. of suitable soil D Mound < 2 in. o bible soil
Holding Tank DOther Dispersal Component (explain) 11 Pretreatirsent Dpice (explain)
-7-
V. Dispersal/Treatiment
Area Information: ( :L) X 'Y 5 -fMWAO= Res "F I
> LC u. ES 4`f
---4j
, D-
Design Flow (gd)
Design Soil Application Rate(grKisf)
Dispersal Am (sf)
Dispersal Am (at)
propo�
300 1.7
1429
1450
�905 /8�95f-? i"A
VI. Tank Info
Capacity in
Total
#of
Manufacturer
P;rvc I
Gallons
Gallons
Units
j
Nm Tanks
Eximling Tanks
Septie oFliolding Tank
X
750
WIESER
X
Dosing Cbsinber
Vill. Responsibility Statement- 1, the undersigneAl, assume responsibility for Installation of the POWIS shown on the attached Plans.
Plumber's Name (Print)
PAUL
ber's Signature
I
MP/MPRS Number
1225410
Business Phone Number
7152462660
R KOEHLER
Plumber's Address (Street, City, Stec, Zip Code) -
321 WISCONSIN DRIVE NEW RICHMOND W1 54017
VIII. Co"un partment Use Only
Permit Fee Date Issued i*Agcnt Signs
Issu
)9 Approved 0 pisaimlo�v --Oon
S ?/L/W2�4
0'10� Re for Denial Z-2-
IX. Conditions o(Apiprovao
S YSTEM OWNER.
Septic tank. effluent filar Amd
dispersal rel� must be scfvic-ed I rna�ntain
as per management plan prcvided by plumber. L11L
21 All setback requirements must be maintained -Y-1
ab p�j dppiluouiv uuu�rv! Loinassuissompiem Puns lor toesystem ty onty cp j1per not ku than 9 112 x I I
du q-zi�i im."cx- ii or 4�
z
(*-01
f)jj&_
cafy-b� -!�� C6
rn 0C 6e-�
5
S43
O-YA
f
oil
-Z Z,-Af,, (1-1 % 11 1
1� A I
i U; cvrnc,4 t
Too "to, 4 A' ilo -1. 0
-VI-
q 0
P'tj el cl -)IS
9,'-k.3 95 -D
scastc,�,
wisc-bm'q�
T.3o R�Lj
Scot I(,
10 Pel
jbo
L
Lr-
I
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: MARY STIJEVE
Owners Name:
Owner's Address: 1708 85TH AVE
NEW RICHMOND WI
Legal Description: SE 1/4 SW 1/4 SECI T 30 R 19W
Township: SOMERSET
County: ST CROIX
Subdivision Name:
Lot Number
Parcel ID Number:
Designer/Plumber
Date:
Signature
032-2005-40-000
Page I
Index and btle
Page 2
Plot Plan
Page 3
System Sizina & Cross -Section
Page 4
Filter Specs
Page 5
Maintenance Information
Page 6
Management Plan
Page 7
St Croix Cty Septic Tank Maintenance Form
Page 8
Warranty Deed
Page 9
CSM or Plat
Attachments: Soil Test & House Plans
PAUL R KOEHLER License Number 225410
06/02/2022
Phone Number (715) 246-2660
Designed pursuant to the In -Ground Soil Absorption component Manual for POWTS Version 2.0 SBD-10705-P (N.01101).
Page 1
j5w�, � e-7
LA
<2'
'L 6
b
�,7 WA a
.;krI
ci r
->Cl 91
OA
rOWd Q��-L vis
V
SOIL ABSORPTION SYSTEM DETAIL I GRAVELLESS LEACHING UNIT 1 1
pop OL.�
Project Norm: MARY STUEVE
2
No. of Cells
3
ft Call VVIdth
45
ft Call Length
3 _
ft Coll Spacing
4.5 Per Coll
9 —Total No of 10
50 aq ft EISA Per Call
450 sq ft Total EISA
usnorls,'4... sm� A —A—. __�
EZ1203H-5ft
My
250
EZ1203H-lDft
10Z
.0
50'
Gravelless Leaching Unit Manufacturer INFILTRATOR
Gravellesa Leaching Unit Model: EZ1203H-10FT. /5
V,� t..SL A, -
Typical Cross Section
Finished Gra4 9 Ift
Observation Pipe with
approved cap or vent
In
Z., �'
12 in
4f I/
_��Slottad and Anchored Vent/
I Observation Pipe with Cap
as
games .... ;a
was
Plumber/Designer Signature:
PAUL R KOEHLER
Soil Backfill
Gootextile Fabric
Ucense #-. 225410 Date: JUNE 2ND 2022
ft InflotraUve Surface
Limiting Factor
V
a
4* CAST -A -SE
0
w
Lo
INLET
<
L)
2
" CAST -A -SEAL
OUTLET
T
\�PUIVIP PAD
WLP750-MR
TANK SPECIFICATIONS
a.
DIME?4SIONS-
WALL- 2 1/2-
BOTTOM: 3"
COVER: 50
MANHOLE: 240 I.D. PRECAST CONCRETE RISER
HEIGHT� 54'
OUTSIDE DIAMETER: -r-00
BELOW INLET: 42'
LIQUID LEVEL:- 3r
WEIGHT. 6,150 LBS.
INLET AND OUTLET:
e CAST -A -SEAL BOOT OR EQUAL GASKET
INLET AND OUTLET BAFFLE AND FILTER:
WISCONSIN, SEE DETAIL #10
(OTHER STATES SEE CHART)
Lu 2
LIQUID CAPACITY: 20.28 GALAN
HOLDING TANK:
Lu
OUTLET HOLE PLUGGED
ACTUAL CAPACITY: 790 GALLONS
LOADING DESIGN: 8*-0* UNSATURATED SOIL
TANK CAN BE USED AS.-
C-4
SEPTIC / HOLDING / PUMP OR SIPHON
Lu
COVER: MIX DESIGN #8 (NO FIBER)
6
TANK: MIX DESIGN #10 (STRUCTURAL FIBER)
Lu
CUSTOMIZED TANKS:
FOR CUSTOM TANKS CONTACT WIESER CONCRETE
REVIEWED BY
REVIEW DATE
CL
DRAWINGS SUMMED
FOR APPROVAL
APPROVED BY:
APPROVAL DATE:
PRODUCTS NEEDED BY:
POWTS OWNER'S MANUAL & MANAGEMENT PLAN . Page I Of I. -
FILE INFORMA1nON
Owner MARY STUEVE
Permit I I
DESIGN PARAMETERS
Number of Bedrooms
2
0 NA
Number of Public Facility Units
IX NA
Estimated flow leverage)
200 gaVday
Design flow (peak), (Estimated x 1.5)
300 goVday
Solt Application Rau
.7 gaildaylW
Standard InfluenttEffluent Quality
Monthly avwage*
Fats, Oil & Grease
(FOG)
:530 mg&
Biochemical Oxygen Demand
(BODg)
:=O mg/L
0 NA
Total Suspended Solids
(TSS)
:5150 mg/L
Prevented Effluent Quality
Monthly average
Bicicharrfical Oxygen Demand
ISODs)
.00 mg1L
Total Suspended Solids
(TSSI
nO mg/L
0 NA
Fecal Collform (geometric
mean)
:0 0" cfu/1 OOMI
Maximum Effluent Particle Size
Yj in din.
0 NA
Other:
0 NA
*Values typical for domestic wastowner and septic tank effluent.
MALIMMANCE SCHEMILF
SYSTEM
Septic Tank Capacity
750 gal
0 NA
Septic Tank Manufacturer
Wieser
0 NA
Effluent Filter Manufacturer POLY LOCK
El NA
Eftent niter Modal
525
13 NA
Pump Tank Capacity
gal
X NA
Pump Tank Manufacturer
IN NA
Pump Manufacturer
10 NA
Pump Model
IX NA
Pretreatment unit
0 Sand/Gravel Filter
0 Mechanical Awartion
0 Disinfection
13 Pow Filter
0 Wetlend
0 Other:
K NA
Dispersal Call(s)
OL "round (gravity)
0 At -Grade
0 Drip -Line
13 NA
0 In -Ground (pressurized)
0 Mound
0 Other:
Othw.
0 NA
Odo:
13 NA
Other
13 NA
Service Everrt
Service Frequency
Inspect condirtim of tankis)
At low once every:
3 D month(s) (Maxknwn 3 yam)
Wyear(s) -
0 NA
Pump out contents of tankle)
When combined sludge and scum equals one-third %) of tank volume
0 NA
Inspect dispersal call(s)
At least once every:
0 monthis)
3 G yeants) (Maxlrmsm 3 years)
13 NA
Clean effluent fitter
At least ones every:
13 month(s)
1.1 PC year(s)
0 NA
Inspect pump, pump controls & alarm
At least once every:
0 month(s)
0 year(&)
NA
Flush Isterals and pressure test
At least once every:
0 month(s)
E3 year(s)
NA
Other
At least once every:
0 month(sl
E3 yearis)
IXNA
Other.
A
IN I
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cobs shall be made by an indivitiusi carrying one of the following license& or cartIficatioris:
Master Plumber; Mastor Plumber Restricted Sewer; POWTS Inspector POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tankis) 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 call(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent an the ground surface. The ponding of effluent on the ground surface may Indicate a falling 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 (Y3) 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,
Memnsin Administrative Code.
All other services, including but not limited to the servicing of effluent fitters, mechanical or pressurized components, pretreatment
unift, and any servicing at intervals of :S1 2 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.
START UP AND OPERATION Page 7� of 7-�-
For now construction, prior to use of the POWTS check treatinent tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal caills). If high concentrations we 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 we 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 call(s) in one large dose, overloading the call(s) and may rmwtt 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 Maintalner 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 calls. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feat down slope of any mound or at -grade soll absorption area.
Reduction or arknination 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; degreaseirs; dental floss; diapers; disinfectants; fat
foundation drain (sump pump) water; fruit and vegetable peeiings; gasoline; grams; herbicides; most scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWrS fails and/or is permanently taken out of service the following steps shall be taken to insure that the systern is
property and safety abandoned In compliance with chapter Comm 83.33, Wisconsin Administrative Code:
0 All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
0 The contents of all tanks and pits shall be removed and property 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 whh
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS falls and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant
replacerrient system:
A suitable replacement area has been evaluated and may be utilized for the location of a repiaoarnent 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 replacernent area will
result in the- need for a now soil and site evaluation to establish a suitable replacement area. Replaceiment systems must
comply with the rules in effem at that time.
[3 A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWrS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
IN
x5an k
13 Mound and at -grade soil absorption systems may be reconstructed In place following removal of the blornat at the
infiffiti stive 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 ANDIOR 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 COUNTRYSIDE PLG AND
Phone 715 246 2660 9
POWTS MAINT'AMER
Name PAUL R KOEHLER
Phone 715 246 2660
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name POWERS SEPTIC SERVICE Name
Phone 715 417 1429 Phone
This documem was drafted In compliance wtth chapter Comm 83.22(2)(b)(1)Id)&(fl and 83.54(l), (2) & (3), Wisconsin AdministrItive Code.
ST R TY SANITARY SYSTEM File#-.
�c —ftfsclaoz".-V�. Offlce U" Only
I OWNERSHIP/ADDRESS FORM CMDWZ#2021
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. if you would like to view your issued sanitary permit online, you can
do so by using the Prgpeft Files Scanned, weblink.
Owner/Buyer MARY STUEVE
Mailing Address 1708 85TH AVE
City/State/Zip NEW RICHMOND WI
Phone Number (required) 979-417-4174
Email Address (requireciMARYKARST@HOTMAIL.COM
Parcel Identification Number 032-2005-40-000
(found on the property tax bilD
Property Location SE i/,, SW 1/4, Sec. 1 T 30 N R 19 W, Town of SOMERSET
Subdivision Plat:
Certified Survey Map
Volume . Page #
Lot # —.
Warranty Deed # (before 2006)Volume ' Page #
Number of bedrooms 2 Spec house 0 yes E no Lot lines identifiable 0 yes 0 no
New Property Address
(Verification of new address required from Community Developmerh Department for new constructionZ)
(Staff Initials) (Date)
This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications.
Now System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified
survey mop if reference is made in the warranty deed.
Community Development Department — Land Use Division
715-386-4680 St. Croix County Government Center 715-245-4250 Fax
cdd(&sccwi.go 1101 Carmichael Road, Hudson, WI 54016 wwwsccwLgo
Parcel #: 032-2005-40-000
07/15/2022 03:49 PM
PAGE I OF I
Alt. Parcel M 01.30 19 483B 032 - TOWN OF SOMERSET
Current . X ST CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
00 0
Tax Address:
KIRK STUEVE
MARY K STUEVE
1708 85TH ST
NEW RICHMOND WI 54017
Districts:
SC = School SP = Special
Type Dist#
Description
SC 3962
SCH DIST NEW RICHMOND
SP 1700
NORTHWOOD TECH
Legal Description: Acres: 0.000
SEC 1 T30N R19W S112 OF SW SW LYING N OF
RR
Plat: * = Primary
* N/A -NOT AVAILABLE
Owner(s): 0 = Current Owner, C = Current Co -Owner
0 - STUEVE, KIRK
C - STUEVE, MARY K
Property Address(es): Primary
* 1710 85TH ST
Notes:
8/31/2020 ADJUSTED TPIN DESC TO MATCH
DEEDS OF RECORDS AFTER RESEARCH TO 1986.
Parcel History:
Date Doc # Vol/Page
Type
06/10/2020 1104463
WID
07/16/2012 959960
WD
10/07/1996 550476 1202/125
WD
02/2111990 456051 864/16
AFF
MM ...
Tract: (S-T-R 40% 160% GL) Block/Condo Bldg:
01-30N-19W
2022 SUMMARY
Bill M
Fair Market Value:
Assessed with:
Use Value Assessment
Valuations:
LastChanged:
04/07/2021
Description
Class
Acres
Land Improve
Total
State Reason
RESIDENTIAL
G1
1.000
15,000 11,700
26,700
NO
AGRICULTURAL
G4
4�000
500 0
500
NO
UNDEVELOPED
G5
15000
25,000 0
25,000
NO
Totals for 2022:
General Property
Woodland
Totals for 2021:
General Property
Woodland
20.000
40.500
0.000
0
20.000
40.500
&000
0
11,700 52,200
0
11,700 52,200
0
Lottery Credit: Claim Count: 0 Certification Date: 09/2812017 Batch M 17-07
Specials:
User Special Code
Category
Amount
Special Assessments Special Charges Delinquent Cha es
Total 000 0.00 Too
019366114 4fast
612912022,12:47:12 PM 1:4,514
0 0.03 0.06 0. 11 mi
Pubic ROW Private Right-d-Way Shavlanid Overlay District C—I 1000 FT LakwPoM i 0 1 , —�j
Lot Tax Parcels C3 75 FT Bulking Setback Flood Kazard Areas 0 0.04 0.09 0.17 km
Limited Conwrion Spam or Park M subdrvismrsm Bomanes M 300 FT RKw/Stream ZONE A WOW SCC COD. 3CC Coo and 50C V4 �p Doo. SOC CDO. FEMk
soc COD
Web APPSU@dw fm AMGIS
SCC COO I WDM. SM COO I SCC COD &W SCC 10Mq, DW I FEMk SCC CDO I CDD and NPS I