HomeMy WebLinkAbout004-839-08-5213-SAN-2020-232Industry Services Division1400 E Wsshiagton AveP.O. Box 7162Madison, W1 53707-7162/S'7Sanitary Permit ApplicationIn accordance with SPS383.21Q), Wit. Adm. Code, submisiionof thii ibnntothe qipropriate govenusental unitis required prior to obtsinisg a samtary permit. Note: AppIicatioD fotiiu lor state-owned TOWTS are submitted tothe Dqjmtiuent of SafiXy and Ptofasional Services. Penooal inibnnatioa you provide may be used for secondarypumosea in armrdatye with die Privacv Law, s. lS.04(11fm). Stats.L AppBcationlnfonnatioD—PleaaePrintAlllpfongationCountyG*=v.C-y~erSanitary Permit Number (to be filled in by Co.)^^7^39Stflte TnBiS8ctioo NunbeiPrefect AddreM (ifdtffcmt tfan nuuling iddreu)3.0.Ii;Property Owner's NameParcel HProperty Owner's Mailing Address10 i-i ii~j HO-O-t *>77Property LocationOovt. LotCity, StattZip CodeTL Type of Bailding (check ail that apply)or2 Firniilynwlling-NumberofBedroomsD Public/Commercial - Describe UseD State Owned-Describe UsePhone NumberLota54, Section(circle one)_Bor^l(aSubdivision NameBlock aCSM NumberD City ofD Village of^Town of CTnL Type of Permit: (Check only one box on line A. Complete line B if eppllcable)A.ew SysttmD Replacement SystemQ Treatment/Holding Tank Replacement OttlyD Odier Modification to Rviaing System (explain)B.D Permit RenewalBefore ExpirationD Permit RevisionD Change of PlumberD Permit Transfer to NewOwnerList Previous Permit Number and Date IssuedIV. Type of POWTS Syatem/Component/Devicc; (Check all that apply^Non-Pressurized In-Ground □ Pressurized In-Ground Q At-Grade □ Mound>24 in. ofsuitablesoil D Mound <24 in. ofsuitable soilD Holding Tank D Other Dispersal Component (etqtlain).D Pretreatment Device (explaia).V. DiapertalfTreatment Area InformationtDesign Flow (gpd)Design Soil Applicatiao Raic(gpdsi). 1-Di^etsal Area Required (sf)'■fX -c" ■Dispersal Ateaftoposed (sf)Systesi Elevatioo93 -VL Tank InfoCapacity inGallonsNewToksTnloTotalGallons«ofUnitsManu&cturer8IIa. OSepde er Holdmg Task/^TCDostsg ChdsbcfVIL Responsibility Statement- L the undersigBed, assume responsibility fbr lg«««ti«tion of the POWTS shtnvn on the attached r>«"«PlPlMPumber's Name (Print)Jerry Ruid Excavating, LLCumba's Signanire"(T'/MFRS NumberBusoiess Phono NuoibcrC(Cj-x-PIuidxX/VJfsdleSMJne^ (Inyi Etce^ip Code)Stone Lake, Wl 54876VUL Coiinty/Department Use OnlyD DisapprovedQ Owner Gives Reason for DenialPermitFeeDale IssuedIssuing Agent Signature1imDC Contiitions of Approval/Reasons for DisapprovalORIGINALrefunds AFTER'SSUE OF permitAttach to cenplete plans for the system ssd wbmli to the Coaaty only ob paper not less than 8 1/3 x 11 Inchcn InZONINGSBD-6398 (R. 08/i4)
Pg1cif4Pg2of4Pg3of4Pg4of4In-Ground Gravity PlanIndex & Cover SheetComponent Manu^ Dosigi References:Version 2.0, SBD-10705-P (N.01/01. R. 10/12)Index & Cover SheetPlot PlanDispersal Area Cross-Section & Plan ViewManagement PlanPAGE 1 OP 4Attachments:Endosimw:POWTS Application for ReviewSoil Evaluation Report & Site MapProject Name / DescriptionOwnerNamsTet! PhCHie:OwnerAddrees! jO^//7 sr' U>ir zin: SH7S'IPrelect Addteee: K/CGevtL^ ^1/4 of 1/4.Secaon .t 3\ n-r b eOotWTowntilip: ; ^ ^ co.t/-<-/^c>^y County:ProfMt Parcel ID #:,Designer InfbrmatlonOtmtrltm: Phon.: r/r.-nz. ascRDeeloner Address! Stona Lake. Wl sdsyfi Zip:E-niafl: ^ @ C-gAJTurVT^/ « wa-V This space reserved for ^provol stamp.Ucenae NumfaenSignature:OrtanddsnMurtiaeAadenaoehfluflubmBMeep^Date:M— CLc'i.o
CtaeXBOXMAPRJCMU.n SOIL EVALUATIONSITEMAPPROJECT NAME:BrUAJrJPROJECT ADnCBS:CHECK BOXASAPPUBIIBI&SC^I's^O*1 1>y>5<K10*1^ SYSTEM page 2 OFPLOT PLANDEKOWFUIW! ^ QPPAttach dMien flow GSkuWom far eommaceW plans.BHSymbei:<^ BUBmOor.FTbmomo^sbrCP WiasynMffosiiicBCle); QTtndMineraityOhOokimmentoocnpribtos^ MalBfiBi / ASTM Stsndnd (Tiaie8384^&384.30«}4*ueu.FcwiMrtc /_ jMEfiBaMmShow graund atowflcn ecRkxBB at suitiUe htonalB.Lo<.c^ C^^reJ^ U^S1 ^=^6,^2.*^8-0. iy sa-s"Sv; s*nsr»-«.Jerry Ruld Excavating, LLCW208 County HWY AStone Lake, Wl 54876e.sT''
IN-GROUND GRAVITY DISPERSAL AREAUniform Elevation Trenches with Quick4 Standarti-W Chambere3-fl Trench (down-sizing credit)BMe T«k(() kMndUnrr--7^-0.Sawc Vclifna(*);SOL COVEREffluM RIMr IEffluvH FRtV MoM IK .TYPICAL TRENCHCROSS SECTION VIEW(No Scale)OuieM8tMamWw/EndC«p.— (lypieai)Systsm ElavBUon >(typlctt)(Show location of Inlot / outlet pipe connediui on plan view.)^ ^h *"-^6 ft(lypleil)INSTALL PER-mENCH:_(L— Qulck4 Stci-W @ 20 ff EISA/cfumtwr n ft'' PalrBofendcapsgefPEiaA/palr-"PropoeedEISApeftreneH. ff Reoulred fnflltTattI* ft* RequlredlnflltTattoPiDvifle mintmuni 3 fteepandlon batiwen tranchee.ObMivManta(WaOMM gw TTwuhanra/ noiocra.TYPICAL TRENCHPLAN VIEW(No Scale)A»3.0ft(WM)^-Qulcl(4 Standard-W Chamber(lypitai)(mW ty InBwlof 9>»liii». Ina)Intai pinuantD mamitgrtiiVa tieuOtatti.nAfaaeX _ trenches = Proposed Total EISA = '•Vs"'X ««Distribution Method:C.-.( {I f- y
HLEINFOHllCTIONPOWTS OWNER'S MANUAL & MANAGEMENT PLANSYSTEM ^ancATioiePago..of.Permit#DESK»ie<«Uyi<EtEMNumbaofBeckoome0^ DNANumba of Public Fadlity UnitsS-NAEstknated (average) flowI.C'O' gai/davDesign (peak) flow »(Estlmaed x 1.5)'hcM'j gai/davIn atu Soil Applicaflon Raeoal/dav/fl®Standard influent/Effluent QualityFats, Oil & Qrease (FOQ)Biochemical Oxygen -Demand (BODs)Total Suspended Solids (TSS)Monthly average*^Omg/L£220mg/L jg^NA£l50mg/LPrareated Effluent QualityBiochemical Oxygen Demand (BODs)Total Suspended ^llds (f^)Fecal Conform (geometric mean)Month^ average^Omg/L£30mg/L ^NASl0*cfu/100mlMaximum Effluait Partlde Size%lnda ^NAother□ NATank Manufacturer DNA□ Dose □ Holdng vol. TS'o galTank Afenufacturer□ Sqjtic □ Dose □ Holdngvol.galEffluent RIter ManufacturwEffluent Rlter Model /.-t"□ MAPump ManufacturerPumpModdPretreaknent LMt□ Sand/Qravd Rlter□ Mechanical Aeration□ DisinfectionManufacturer®iA□ Peat Rlter□ Wetland□ Other;mn-Qround (gravity)□ At-Grade□ Drlp-Une□ NA□ In-Qround (pressurized)□ Mound□ Otho-;other;□ NAOther:□ NAMAIMTEWANCESCHBULEServfeoEvantSmviee FhequeneyInspect concfltlon of tar*(s)At least once every: (Maximum 8 yeare) □NAPump out contents of tank(s)aWhen conblnsd sluc^e and scum equals oniMhIrd (J® of tank volume „□ Whmi the h^liwat^edism Is activatedInspect fflspasal cai(s)At least once every: (Maximum 3 yeara) □NAClean effluent filterAt least once every: \ □ NAInspect pump, pump controls & aimmAt least once every: □ ^Rush laterals and pressure testAt least once every: ByK!®^Other:At least once every: BSlrS®' DNAOther:□ NAMAINTENANCE INSTRUCIIONSIrap^ons of tanks and diqtmal cells shall be made by an Individual canylng one of the following licenses or certlflcatlons: MasterPlum^; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintalnen Septage Servicing Operator (pumper). TankInspection mist Include a visual Inspection of the tank(8) to Identify any missing or broken hardwve, Identify any ciai^ or leaks,measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. Thedispersal cell(8) shall be visually Inspected to check the effluent levels In the obsearvaOon pipes and to check for arty ponding of effluaitot effluent on the ground surface may Indicate a falling condition and requires the ImmecBatenotification of the local regulatory authority.Whafi the combined axumulation of dudge and scum In any treatmart tank equals one-tWrd (H) or more of the tank volume, the oiUrefwnoved by a Septage Servicing Q)erator and cDsposed of In accordance with chapter- NR113, WisconsinAcbnfntetraiivG Codo.AH other sa^rioes,-lncluding but not limited to the senrldng of effluent fflters, mechanical or pressurized components, pretreatment units,and any savldng at Intavals of S12 months, shall be performed by a ootified POWTS Maintaina-.A savice raxrrt shall be prmrided to the local regulatory authority within 10 days of compiaion of any savlce event.QMW (12r02)
'start UP AND OPERAHONFor new coralruciion, priw to use of the POWTS check treatmart tank(8) for the presence of palitfng products, solveote or otherdMnilcal8ttiafmiqrbn]Mde thebeeSnentproos8saKik)rtikunagethesoB(^)er6alce!l(8). If hkth conoenlratlone ge detecM haw thectmtenis of the tai*(e) removed by a eeptase servicing (k)eFat(»'prior to use.Sj^tem start up Shan not occur when edi cmdtions are frozen at the Infittrative sirface.During extended poww outagse fsimp tanks may fill above normal highwater levels. When power Is reetored the eroeese wastewater willbe Aoharged to the dispersal odl(8) In one large dose and niay overload them resulting In the backup or surfBce cisdnige of effluent.To avoid this dbmtlon have the contents of the pump tank rwnoved by a Septage S^dng Operator prior to rertoring power to theeffluent pump or contact a Rumber or POWTS Malntsiner to assist In manually operating the pump controto to reetoie normal ievelewitl^ the pump tank.Do not drive or park vehides ovor tanks and cflsperscd cells. Do not drive or park ovw, or otherwise disturb or compact, the area wffliln15 feet down slope of any mound or atgrade soil abeorptlon area.Reduction or elimination of the following from the wastewater stream mt^ Improve the perfonnanoe and (soiorki the Dfe of the POWTS:anillriotlcs; baby wkres; dgarette butts; condoms; odtm ewdbe; degreceets; denial floss; diapers; dislnfeotmts; fat; fOundadon dialn(sump ptsnp) dsotudge; fnilt and vegetdrie peelings; gasdine; grease; hwUddes; meat scrape; mecBcalons; oO; pdnting products;peeflcktes; sanitary nqsWns; tampons; and vrater softener brine.ABANDONMENTand safely abandoned in oompHance with diapto- Comm 83.33, Wisconsin AdnlnlstraUve Code:• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.• The contents of aO tanks and pits shall be removed and properly dspoeed of by a SeiMageSeivldng Operator.• After pumping, all tanks and pits shall be excavated and removed or thdr covws removed and the void filled with soli,gravel or another Inert soBd material.C0NTBIQB4CYPLANIf ftie POWTS falls and cannot be repaired the following measures have been, or must be takm, to provide a code compliantreiriacement system:□ A sirit^ replacement area has bewievaltmted arid may be uflUzed for the locafion of a replacement s(£id»orplionsystem. The replaoemwit sea ^ouid be protectedfromdisturixuice and compaction and should not be bdrbiged upon byrequired setbacks from eodsfing and propo^ structure, lot Ones and wNls. FaDuie to protect the replaoem^ area winresult in the need fm'a new sdl and 8^ evaluation to establish a stdtabierei^acement area. Retriacementwstememustcomply with the mies In effect at that ttne.A ndtaUereptaoement area to not avallabie due to setback and/or son llmttaflons. Barring advances In POWTS technologya hddr^tartt may be Installed as a last resort to replace the faUed POWTS.The site Iks not been evaluated to Idenfliy a suitable replaconem area. Upon failure of the POWTS a son and siteevdiiatlon must beperformedto looato a sultaUs repktcement area. If no refriacemmtarea Is avaflNiie a hokHng tank maybe Inetaned as a last resort to repboe rite faUed POWTS.□ Mwndand at-gradesoH itootptlon systems may be reoonstruoted In place following removal of the biomatattheInflltrative surface. Reoonstmcflons of such systms must comply with ttrendes In effect at that tbne.«WARMNG>»SgnC, PUMP AND OTHER TREATMBirTAIBCS MAY CONTAIN LETHAL PASSES AiayORIIIBUFHCIBITOXVaaL DONOTBnSIASSIICiPUiPCmOTfSRIIlEAlMBfTTAIICUIBNERiUIYCIRCUiaTMICeS. DEATH MAY IffiSULT. RE8CUE0PAPERSON PROM THE INTERIOR OT A TANK MAY BE DIPRCULT OR IMPOSSIBLEADDITIONAL COMMENTBPOWTS JMBTpnNameRione•7'S'-POWTS IIAIMriaiffiRName r oPhoneSgTAOE SERVICINQ OPERATOR fPUMPERINamePhmeLOCAL RMU^TORY AUTHORfTYName S /ZPhone 3 y- 32.33TNs deeumsntwSidrWIsd by the staffs of the Grssn Lake, Marquslie and Waushsra County Zoning and Santtatlon saen^w in cennOanes elth chSBlsrComm e3.22(2)(b)(l)(d)a(0 and S3A4(1), (2) & (3), Wisconsin Adrrfni8trstiveC«^^^ m «»iipuanB. enn onapar