HomeMy WebLinkAbout014-114-01-0300-SAN-2020-028Industry Services Division1400 E Washington AveP.O. Box 7162Madison, WI 53707-7162• TT i /u/—/ JOZfcsT n - mipTicationCountySanitary Permit Appx.^«i.xuiiIn accord^ce with SPS 383.21(2), Wis. Adm. Code, submission ofthis fom to the appropriate Rovemmental unitf Application forms for state^wned POWTS are submitted tothe Department of Safety and Professional Services. Personal information you provide may be used for secondarvputposes m accordance with the Privacy Law s 1 ^ q..,. ' ^ may oe usea tor secondaryL Application Information - Flense Print All InformationfVoperty Owner's Name _k Crco'k'^..-Property Owner's Mailing Address' l'7X'-( l\JCity, StateC Kkvk fi le»-vrv7 /Aa/nType of Building (check all that apply)& ! or 2 Family Dwelling-Number of Bedrooms ^Zip CodeiTSTS iC?Phone Number0 Public/Commercial - Describe Use A>D State Owned-Describe Use /S\Lot#3Block #CSMNtunberSanitary Permit Number (to be filled in by Co.)6>/99ro>Stale Transaction NumberProject Address (if different than mailing address)/ 2 i 7PA.(/1Of)Parcel Ho'^ih ^o/oSaaProperty LocationGovi. Lot^ Section "2. 3(circle one)T N; r3 Eoi^Subdivision Namec9i_r<^ —□ City of_D Village ofIJ'Town of Z. tf/x/feStTTm. Type of Permit; (Check only one box on line A. Complete line B If applicable)^^stem □ Replacement System □^^(Hol^ank Replacement Only □ Other Modific-ron to Existtng Sy«em (expi;;^IV. Type of POWTS System/Componcnt/Devlce: (Check all that apply)>etmil Number and DateJssuet•'M ,List Previous Permit Number and DatejssuedXNon-Pressurizedln-Ground □ Pressunaed Inland □ At-Orade □ Mound >24 in. of suitable soil □ Mound <24 in. of suitable soil□ Holding Tank □ Other Dispersal Component (explain) □ Pretreatment Device (explain)V. DUneraal/Treatment Area Informatlop!Design Flow (gpd)Design Soil Application Rate(gpdsf)■ ?•VL Tank InfoCapacity inGallonsDispersal Area Required (sf)New TanksExisting TanksTotalGallonsOofUnitsDispersal Area Proposed (sf)t78ManuftcturerSystem Elevation1161£ Oo■aSeptic or Holding Tank/OCt>Dosing ChamberVII. Responsibility Statement- I the undersigned, assume responalbllity for InstallaMon of the POWTS shown on tbe attaebedumber's NaPlme QTint)Jerry Ru1d Excavating, LLCCfty^ttAip Code)Stone Lake, Wl 54876umber's SignatureMP/MPRS Numberj.plans.Business Phone NumberVIH' Co^nfr/Department Use Only0D DisapprovedD Owner Given Reason for DenialPermit FeeooDC. Conditions of Approval/Reasons for DisapprovalORIGINALDate IssuedIssuing Agent SignatureNO REFUNDS AFTERISSUE OF PERMITSBD.6398 (R. 08/14)Atttcfa to conplote pLitu for the sytteo and submit to the County only on paper oot leu than 8 i/lfx-l UhJbaS i ^ 2020SAV-ZYER COUNTYZONING ADMINISTRATION
Pgl of 4Pg2of4Pg3of4Pg4of4In-Ground Gravity PlanIndex & Cover SheetComponent Manutd Deslspi RefBrences:Version 2.0, SBD-IOTOS-P (N.01/01, R. 10/12)Index & Cover SheetPlot PlanDispersal Area Cross-Section & Plan ViewManagement PlanRAGE 1 OF 4Attachments:Enclosures:POWTS Application for ReviewSoil Evaluation Report & Site MaoProject Name /. DescriptionOwner M Phono: - _OwnorAddroM: //73H Aug. A/. Zip: •S'S'aiQaPitJoetAddrooo:Oovt Lot: 1/4 of ^1/4, SecHon . T N-R ^ Eflor Vlf \E\Township: ce>o c Counfy: SPioiectParcsHD#! 'HHHo io^oc^Designer InformationJerry Ruld Excavating, LLC n urPtWaOOOeunlyllWYA Phone. 2.Md^DeetenerAddfeee: Stone LakSr Wl 54R7ft zio:Designer Name:E-inaB:"3Tcj<.c^ (^3 »■Ucense Numben ^This tyflce rooved &r ^iovbI stamp.wgnKUiw rmuData:
S VitvT ^ or<^cvi>w» C r I <_ ^f'-So/O' / ^ J. o A^o e— 1^,VOcNSc"^ L-wk-e_h-• i■XS- 5*0'=\&.SN >Tovn. ^3. S"«R^oo'C^ 7^1.0 —A- V/Af. Tcip o^ X»-o.oP'Pd^ 'W9«0W^</ To r^>e£f S/T-WtfifcSJeny Ruld Excavating, LLCW208 County HWY AStone Lake, Wl 548769-^(S^-^
IN-GROUND GRAVITY DISPERSAL AREAUniform Elevation Trenches with Quick4 Standard-W Chambers3-ft Trench (down-sizing credit)SOL COVERSeptic Tank<e)Manuf»cPmr //occ/is«ciSepPc Tinfc{e) Vckina(>):t EffiueiV Filter MenuteouierEtfbenl Filter Modeif:TYPICAL TRENCHCROSS SECTION VIEW(No Scale)QulcX4 StandarcMiVw/ End Cap.— (typlMl)Syatam ElevaUon(typical)(Show location of inlat I outlet pipe connection on plan view.)Provide minimum 3 ftseparation tMtween (ranches.OOaefvBofi(typUOimoi p«f maraAcBMny ntnjcQGM.TYPICAL TRENCHPLAN VIEW(No Scale), ^ ^ ^f 4^ aB= Vfe fl(lyplesJ)INSTALL PER TRENCH:AgS.OftI (hPfcel)^QuickA Standard-W Chamlter(tyjtoi)(mfa er mimterstana, m)Inetel pciruent b rnaiutecbren hetfUflPont.it i-n Inetel pciruent b rnaiuti1/ t3uieki»Slel-WiQ20fPEISA/cftamt>efg -L C O ft'' Pairs of end caps @ 6 ft* EISA/pair = ff" Proposed EISA per trench g .22 (t? ft' Required Inflltratton Area = ft*X ^ trenches = Proposed Total EISA = 0 te=Distribution Method:
PAGE 5 OF 6SEPTIC / PUMP TANK SPECIFICATIONS(No Scale)4VtMf>|palariiivvUftitaMAneharMc(i)MnMi«ypununt to 8P8 383>(9m(B)CAPACmESiaoRirtraa•MSMandlffiBlODOaplh(in)Vdume(8ai)A1LQ>3^o.c?B•24.0"So.^GC3Jq.oiS^c,oDa-o"3*0, &*Puinp Tank Uqidd Laval n HOForoa Main Olametar nForoa Main Lojglh aForea Main Void Vduma[C3 To^ Doaa Vduma fTDV^15(SX total Mato void wiunM<TDV<VMCipiLi-PUMPOFF. ELEVATION <ftar AfpMd Biddhg ItttaM BnMBi ItakINSIDE BOTTOM. ELEVATION n ft"a2Xdntonflaw)♦(tow main datobacfcvotume)MIN. PUMP DI8CHARQE RATE o 3 flpmVertical Head♦ Min. Supply HeadFM Friction Loss ■>,. + Riling Low* «,(nfaLMartrhndxHtoVWto IIMNIII Va«y'iS'^S ftft^ft■ TOTAL DYNAMIC HEAD «PUMP TANK;Vohima ° (o6o galSPPTIQTANKI?!;Total Vdume ■ ) Q>oO galManufiKhiiw:, \eS^rManutaduraria): UJi<tS<r.PumoManufochaen ZoeBerInstall anDmVtMlflfflllpntflHAratttmeanflntonkrviMAlImmadiatalv UDBlmafn of tha mimn tank htatiConbolfl/Aiann ManufiBctureRFlltarMamibclurenConlreiaMiann MocM: 101HWFlItarModak 45.Float awMehaaeontolriMmefia^
I i-Wicr'I— III^ < LL.PUMP PERFORMANCE CURVEMODEL 151/152/153\\10 2040 50 60 70 80 90 100GALLONSLIT6RS0 40 80 120 160 200 240 280 320 360FLOW PER MINUTE01'»50Slillii'//in» >v ivii'nivi .■.nii/<;lviiM.I/.',>ni.M.i/i..lV^-/....ll....i.,.. . , ; .(• ,
RLE JNF0RHA710NPOWTS OWNER'S MANUAL & MANAGEMENT PLANSYSTEM SPEanCATlOtCPage..of.Tank Manufacturer r-cjS-Air□ NAP«mit#l^Septic □ HoitSngvol. JOco£oogalDESIGN PARAMETERSTank Manufacture□ NANumber of Bedromns3□ NA□ Septic □ Dose □ Holdlr^vol.galNumber of Public FadDty Units^NAEfflueit Rite Manufacture i.□ NAEstimated (average) flow3oogai/dayEffluent Rite Modd UTJ.e,Design (peak) flow = (Estimated x 1.5)^s-ogal/dayPump Manufacture□ NAin Situ Sdl An>l1cation Rategai/day/ft'Pump Model IjSTxStandard lnfluent/Efflu«it QualityMonthly average*Prefreatmeit Unit^NAFats, Oil & Grease (FOG)£30mgri.□ Sand/Gravel Rite□ Peat RKeBicdiemlcal Ox^en Demand (BODs)£220mg/L□ NA□ Mechanical Aeration□ WetlandTotal Suspended Solids (TSS)£l50mg/L□ Dldnfection□ OtherPretrmited Effluent QualityMonthly averageManufactoreBiochemical Oxygen Demand (BODs)Total Suspmded Solids (TSS)£30mg/L£30mg/L0NADispersal Cell(s)^In-Ground (gravity)□ NA□ In-Ground (pressurized)Fecal Cdtform (geometric mean)£l0*cfu/100ml□ At-Grade□ MoundMaximum Effluent Particle Size16 India^NA□ Drip-Une□ Othe:ottiw:□ NAOtfier:□ NA*Values typlssi for domestio wastowaler and saptie tank effluentOtirer:□ NAMAIWIENANCE SCHEDULEServloe EventServtoe FrequencyIropect contfititHi of tank(s)At least once evey: Q. (Maximum 3 yeare) □NAPump out contents of tank(s)!^Whe) cenbined sludge and scum equals one^hlrd (1&) of teik volume p, ^.□ Whei the high watedarm is activatedInspect dspersal ce!l(s)At least once evory: ^§ym^r' OUUndmumSyeare) □NAGlean effluent fnteAt least once every: ^Inspect pisnp, pump controls & aiamnAt l«ist once every: \§yMK^^Rush leeals and pressure testAt least once every: BywrSf^Olitsr:At least once every:other:□ NAMAINTENANCE INSTRUCTIONSInspecOons of tanks and disposal ceils shall be made by an Individual carrying one of the following licoises or cotflcations: MastwPlumber; Masto* Plumbw Restricted Sewo'i POWTS inspector; POWTS Maintalner; Septage S«vidng Operator (pumpw). TankInspections must Include a visual Inspection of the tank(s} to Identify any missing or broken hardware, Idoitlfy any cracks 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. Thedisperse cell(s) shall be visually Inspected to check the effluent levels In the obsovatlon jdpes and to dteck for any ponding of effluenton the ground surfaca The ponding of effluort on the grmind surface may Indicate a falling oondtion and requto the Immefflatenotification of the local regulatory authority.Whm the combined accumulallon of dudge and scum In any treatment tank eqimis one-third {%) or mwe of the tank volume, the mtirecont«its of the tank shall be removed by a Septage Servicing Op^w and disposed of In accordance with chapter NR113, WteconsinAdministrative Cede.Ail other swvices, Including but not limited to the servlcir^ of efflumit filters, medianical or pressurized components, pretrsalment units,and any senrldng at Intwvals of £12 months, shall be performed by a c^ed POWTS Maintalner.A s«vlce report shall be (mrvlded to the local regulatwy authority within 10 days of complin of any service event.GMW (12^2)
START UP AND 0PERA110NFor new construction, prior to use of Oie POWTS check treatm^ tank(8) for the presmce of painting [voducts, solvents or othwchmilcals that may Impede the treatment process and/w damage flie soil dispersal ceil(s). If high conoentratiorw are detected have thecontents of the tanK(8) removed by a septage s^vldng operator prior to use.System start up shall not occur when sol! conditions are frozen at the inliitratlve surface.During extended power outages pump tanks may fill above nonnal highwatw levels. Whm power Is restored the excess wastewater willbe discharged to the dispersal cell(s) In one large dose and may ov^oad them resulting In the backup or suifiue (&diarge of ^fluent.To avoid this situation have the corrtwits of the pump tank removed by a Septage S^dng Operator prior to restoring power to theeffluwit pump or contact a Plumt)er or POWTS MalriteJnw to asdst In manually opoatir^ the pump controte to restore normal levelswithin the pump tank.Do not drive or park vdilcles over tanks and disposal cells. Do not drive or park m&r, or otherwise disturb or compact, the area within15 feet down slope of any mound or at-grade soil absorption area.Reduction or dlmlnaUon of the fdlowing from the wastewater stream may Imix-ove the performance and i^dong the life of the POWTS:antldotlcs; baby wipes; dgarette butts; condoms; cotton swabs; degreas«e; doital floss; diapers; (fislnfectants; fat; founctallon drain(sump pump) dischtfge; ftuft and vegetable peelings; gasoline; grease; herblddes; meat scraps; medicailons; oil; psdnting products;pestlddes; sanitary napkins; tampons; and water softwiw brine.ABANDONMENTWhen the POWTS faHs and/or Is pennanently taken out of service the following st^ shall be taken to insure that the sratan is properlyand safely abandoned In compliance with chapter Ckxnm 8353, Wisconsin Acfinlnlstratlve Code:* All piping to tanks and pits shall t>e disconnected and the atiandoned pipe (4)enlng8 sealed.* The contents of all tanks and (As shall be removed and properly disposed of by a Septage S^vidng Opoato'.* After pumfSng, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil,gravel or another Inol solid material.CONTINGENCY PLANIf the POWTS falls and cannot be repaired the following measures have bewi, or must be takwt, to provide a code compliantreplacemoit system:□ A suitable replacemmt area has been evaluated and may be utilized for the location of a replm^nent soli absorptionsystem. The r^>lacement area should be protected from disturbance and compaction and should not be htfringed upon byrequired setbacks frmn existing and propo^ structure, lot lines and wdls. Failure to protect the r^lacemmt area willresult In the need for a new soil aitd ^ evaluation to establish a sultaUe replacement ar«L Replacemmt systems mustcomply wKh the rules In effect at that time.□ A suitable replacement area Is not available due to setbadc andfor soil limitations. Barring advances In POWTS technologya hdcDng tank may be Installed a last resort to r^ace the foiled POWTS.B The site has not been ewduated to Identify a suitable replacemmt area. Upon f^lure of the POWTS a soil and siteevaluation must be perfomned to locate a suitable replacement area. If no replacement area Is available a holding tank maybe Insfolled as a last resort to r^lace the failed POWTS.□ Mound and at-grade soil absorption systems may be reconstructed In place fcrilowing removal of the blmnat at theInfiltrative surface. Reconstructions of such systems must comply with the ndes In effect at that time.«WARMNG»SEPTIC, mmP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOTENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUEOFAPERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLEADDITIONAL COMMENTSPOWTS INSTALLERName^-crPWPhcne ytS'POWTS MAINTAINERName"3rg>f ^ rPhoneSEPTAGE SERVICING OPERATOR (PUMPERINamePhone T/jg-LOCAL REGULATORY AUTHORITYName S C ^PhoneThis doeumant wte (kaftad by the staffs otf the Green Lake, Marquette and Wajshara County Zoning and SenltaUon agencies in ccmpilenoe with chapterComme352(2)(b)(l)(d)&(0 and 83A4(l), (2) a (3), Wiscortsln Administrative Code. r