HomeMy WebLinkAbout010-941-34-3322-SAN-2020-237orv0D,lnOus!ry Services Division1400 E Washington AveP.O. Box 7162Madison, Wl 53707-7162es"r^./q^Sanitary Permit Applicationin secorda.nce'nith SPS 383.21(2). Wis Adm Coda, submission of !his form to Meapproprisie govsmmenal unitIS required prior to obuining a saniary pormii Note Appl.caiioit forms for s:ate-o»-ned POWTS are submined tothe Depanmeni of Safety and Professional Servies. Personal information you provide may be used for secondarypurposes in accordance with the Privacy Law.s. IS.Oefl Ifml. Stats.CountyV-Sanitary Permit Nimber (to be filled in by Co.)State Transaction Number1. Appiicaiion Information - Please Print All InformaiiorsProperty Owicr's NameBgy\ h.. ^ y U lew C . L kaProperty Oi'mer's Milling Address /Project Address (ifdi/Tereni than mailing address)OA. ifLParcels-?V-33Z.^iOnir^s-^fKJ n'BriVw-UICity. Slate[•Wm COtat.r'A.ii. Typ^ of Building (check all that apply)D^r 2 Family Dwelling-Number of Bedrooms,D Public/Commercial - Describe UseD State Owned - Describe Use4.'l( RdZip CodeSH2M9Piione NumberProperty LocationGovi. Loti>0Z-HoZ-639llotsPI, Section, , , icircle one)T M( N ft Eo^Subdivision NameBlock#CSM NumberD City of_0 Village ofIJl.Type^Perrnitr (Check otily one box on line A, Complete line B if applicable)O'Sew SystemD Replace.ment SystemD Treatment/Holding Tank ReplacemeB^own of |-t"eLy LaB.D Permit RevisionD Change of PlumberD Permit RenewalBefore ExpirationType of POWTS Svstem/Componein/Devlce: (Check all thai applynt OnlyD Permit Transfer to NewOwnerD Other Modification to Existing Systent (expiain)list Previous Pettiiii Number and Date IssuedIVon-Prcssuriaed In-Ground □ Pressurized In-Ground D Ai-Grade □ Mound > 24 in. of suitable soil □ Mound <24 in ofsuitable soil□ Holding Tank □ Other Dispersal Component (explain), D Pretreatment Device (expiainl - .V. Dispersal/Treatment Area Infonnation:Design Flow (gpd)M-SOVI. Tank InfoDesign Soil Application Raie(gpdsf)nCapacity inGallonsDispersal Area Required (sf)0H3Dijpersa) Area Proposed (sf)65"2.-S-"System ElevationqswS-'^Vpii^r .HolCingmsTt-il.Dosinc OiiiTrterNew TariksExisiingTtnks'oor>TotalGallonsxm.s'ofUnitsManufacturerToUs §s. UO iJ5 iiC OVII. Responsibility Statement- 1. the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.Plumber'sName(Prmt) ' ^TuRob LaPlumber's Address (Street. City, State. Zip Code)ms-q^ yj s4. .u)[.MJ/MPRS NumberBusiness Phone Number1 tS"-^9q - o9 3 (oV'lllyCflp.nlv/Departineni Use Onlypr^ed ] □ Disapprovedi □ Owner Given Reason for DenialPermit FeeDate IssuedIssuing Ageni Signature;ruiur£htX. Conditions of Approval/Reasons for DisapprovalORIGINAL•SfSfSfiCuM^Artach to compku plaiu for the tysiera ind luhntir lo the County only on pepcrool l0S (hsn S L/2 s M inchei iSBD-6398 (R03I3)
INDEXPAGEApplicationPages/-SeiHrest- ~L~Plot Plan(5--4 crosy-^jgcrl-iDi^ VS-T. d«-V5ni.vi^ g'nAe<.tV4a.LKti^, / M a.iA.aj-gvn-evt-lr ^. K.otMP:Signature:MP License Number: 7-"S-(oZl^Date: 9^2,^-2-^9This plan was designed following guidelines from Department of Safety and ProfessionalServices, DSPS 83 and Design Manual Conventional Soil Absorption Manual, Version2.0.
QuJftgy--.\05fcl nJ. O'Brrco^Al tU.■^cLyu3flLT»(^^ u31 5*4 J434)02,-402.- 434 f5eLuji>|-eT- Co.^ H<=k-^U)<*-r J TZ^Y?\g : OVO— 441 - 34-?3Z2_Sto/sto ^34 -r4l /i.04vjJ3/fcASc«Je r'^Ho'leus\ S'i"fe. iwSd'.IeieoQi-^v\ 35' ^^<9L$5 I—^ VvU'J • E4BH too, To|? ^ D ^'\o'vte.B 1. 48.0 '2.. 403r3. '^^■(^'.1 Soils f ^siei.gld^ Siuiev-i 41^', ST cof- 40.0'
IN-GROUND GRAVITY DISPERSAL AREAStepped Elevation Trenches with Quick4 Standard-W Chambers3-ft Trench (down-sizing credit)SOIL COVERirmtn.lrenchTYPICAL TRENCH ciepihCROSS SECTION VIEW(No Scale)Sepllc Tank(s)Manufaclurorto I'epc y-Soplic TanK(OVolumo(s):, Effluetil nitef Manulficturer:RrlvEffluent Filter Model U:5Z-SProvide minimum 3 ftseparation belween Irennhes,Highest TrenchSystem Elevations= SS iS" fj. -S" f{.QuicM Slandard-Wwl End Capy— (typical)Lowest Trench (as applicable)(Show iocation of iniet I outlet pipe connection on plan view.)OOsetvallon f'lpo(typlc^)Install per mnniifctclucr's/ inslnicUans.TYPICAL TRENCHPLAN VIEW(No Scale)A = 3.0 It(typical)(typical)INSTALL PER TRENCH:to? Qulcl(4 Sld-W @ 20 fe EISA/chamber = fi»I Pairs of end caps 6 ft' EISA/pair = ^ ft'^Quick4 Standard-W Chamber(typical)(mfd by InflHralor Sysleins, Inc.)Inslell pursuant lu manufaclutui's instiuiHIum.= 6H3= Proposed EISA per trench = 3^^ ft' Required infiitralion Area = " ft'X ^ trenches = Proposed Total EISA = qjDistribution Method:Cfraui.
WLP1000-MRTANK SPECIFICATIONSCAST-A-SEALFILTER ORBAFFLE4" CAST-A-SEALTOP VIEW?o[y\o\<^ S-Z-SINLETOUTLETOPTIONAL FLAT COVERIS AVAILABLE FOR EXCHANGEFOR DOME COVER.DIMENSIONS;WALL: 2 1/2"BOTTOM: SEPTIC 3"HOLDING 5" (ADD 1,300 LB.)COVER: 4"MANHOLE: 24" I.D. PRECAST CONCRETE RISERHEIGHT: DOME COVER 61" O.D.FLAT COVER 53 1/4" O.D.LENGTH: 104° O.D.WIDTH: 86" O.D.BELOW INLET: 42" O.D.UQUID LEVEL- 36"WEIGHT: 6.790 LBS.INLET AND OUTLET:4" CAST-A-SEAL BOOT OR EQUALGASKET. CAST-A-SEAL BOOT OR EQUALINLET AND OUTLET BAFFLE AND RLTER:WISCONSIN. ^E DETAIL #10(OTHER STATES SEE CHART)UQUID CAPACITY: 27.83 GAL/INHOLDING TANK:OUTLET HOLE PLUGGEDACTUAL CAPAOTY: 1.085 GALLONSLOADING DESIGN: 8' 0" UNSATURATED SOILMN TANKS:WILL HAVE ONE VENT OVER OUTLETAND WILL HAVE TWO VENTS IN COVER OVER INLETTANK CAN BE USED AS:SEPTIC/ HOLDING/ PUMP OR SIPHONCOVER: MIX DESIGN #8 (NO FIBER)TANK: MIX DESIGN #10 (STRUCTURAL RBER)CUSTOMIZED TANKS:FOR CUSTOM TANKS CONTACT WIESER CONCRETEPUMP PADSIDE VIEW3'TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTSJOB INFORMATION:CUST&VIER:10B NAME:DATE NEEDED:APPROVED BY:APPROVAL date:>■ e... 5o3cccZ£IoooO< CMZ<—>oFQ.OUJV)(7) uocSHEET NO.1^OF1
PAGE ^ OF G?In-ground Gravity Management PlanIMPORTANT:The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant torequirements of SPS 382-384, Wise. Admin. Code. Pursuant to SPS 383.52 (2), Wise. Admin. Code, this system shallbe considered a human health hazard if not maintained in accordance with this approved management plan.Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer inaccordance with SPS 383.52 (3), Wise. Admin. Code.Maximum Dispersal Area Qperatlno Limits:Design Flow = gp^; BOD5 < 220 mgL'^; TSS S 150 mgL"^; FOG<30mgL'^Inspection Checklist INSPECT EVERY 3 YEARSo type of useo age of systemo nuisance factors {i.e. odors, user complaints, etc.)o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.)o material fatigue (i.e., leaks, breaks, corrosion, efc.)o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes)o neglect or improper use (i.e., exceeding design capacities, prohibited activities, efc.)o extent of ponding in distribution cell prior to dosingo dosing irregularities - if appiicable (i.e., pump re-cycling, float switch settings, etc.)o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.)o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification)o surface discharge of effluent or sewage back-up into structure servedMaintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)o Septic and dose tankfsl shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.Stats, when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) oras required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wise. Admin. Code.o Effluent filterfsl shall be inspected every 3 years and shall be cleaned when necessary to remove anyaccumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12months.System maintenance reports shall be submitted to the proper local government unit in accordance withSPS 383.55 Wise. Admin. Code. Report any component failure or malfunction to;Name of individual or company: b>Q-vr-e_ Phone: ^0*2— (Local government unit: v Cd?. oia-\ Phone: ^ItS" — 434 — 82-?^Local government unit address: (QtoKO l)Vla.\ti ^tjt// ZIP:Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wise. Admin.Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wise. Admin. Code.No product for chemical or physical restoration of the POWTS may be used unless approved by the department inaccordance with SPS 384, Wise. Admin. Code.Contingency PlanIn the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant toa plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may beabandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils.System AbandonmentIf use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wise. Admin. Code.
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�;;�?�`'ft'"'^%= PRIVATE ONSITE WASTE TREATMENT county
�X�i a � SYSTEMS Sawyer
�:���5� ( POWTS)
��`�='''�=�����''Y�\� INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION � ��"�
Personal inYonnation you provide may be used for secondary purposes(Privacy Law,s. 15.04(1)(m)] /
Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
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Insp BM Elev: BM Description: Parcel Tax No:
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TANK INFORMAT N ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �.,��-�;. � �,�� Benchmark �� �`� \�;�,.\'j
Dosing
Aeration Bldg. Sewer c(`� `�
Holding St l Ht Inlet �j�7.3
TANK SETBACK INFORMATION St I Ht Outlet �j�7. �
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic �-\� ,-- �\S NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. �� ��'"�
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infiltrative - �,
Surface ��•�
Manufacturer ---- Demand Final Grade �
Model Number �' GPM
TDH Lift Friction loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W � #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate
INFORMATION P I L Bldg Well �raters � GP � Chamber Model Number:
❑ EZFIow
CELL TO ❑ Mound o Other � ��
- — --- —
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— — ------ — —
DISTRIBUTION SYSTEM X Pressure Systems only
Header/Manifold Distnbution Pipe(s) TX Hole Size X Hole Observation Pipes
Length Dia _ I Length _ Dia Spac _� � Spacing ❑Yes � No
SOIL COVER
Depth Over Depth Over T Depth of Seeded/Sodded Mulched
Cell Center Cell Edges Topsoil ❑Yes ❑ No � ❑Yes ❑ N�
COMMENTS: (Include code discrepancies, persons present,etc.)
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Plan revision required?�Yes 0 No � — � �� �� ��-t
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Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A��ITIONAL COMMENTS AN� SKETCH
SANITARY PERMIT NUMBEA: a�- a-�7
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