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HomeMy WebLinkAbout024-175-00-1500-SAN-2020-186<>>V *1Industry Services Division1400 Iv Washington AvcP.O. Box 7162Madison. W1 53707-7162/S/Couniy5aLOSanilury Permit Number (to be lilled in by Co.)Sanitary Permit ApplicationSlate 'j'ransactiun NumberIn accordance with .SP.S 383.21(2). Wis. Adm Cixic. submission of Ibis form to die appropriate govemmenial unitis reiiiiircd prior to obtaining a sanitary pcnnit. Note: Application fomis for stale-owned POWTS arc submitted tothe I3epanmcnl of Safely and I'rorcssionul Services. I'ersoiuil inl'omuition you provide may be used for secondarypurposes in aceordance with the I'rivacy l.iiw. s, 15.04(1 )(iii). Sims.1. Application Information - Please Print All InformationProject Address (if different than mailing address)1 W N Loort 6*y LaProperly Owner's NameN 'r KrxK A Oo-t-ach-nProperly Owner".s Mailing Address\ 0& Vx) KQV^^e r S>\City, StateSue , COXZip CParcel UO-^-l'JS'OO J^-OOProperty LocationUovl. LotodeII. Type of Building (check all that apply)I3[i or 2 Pamily Dwelling - Number of Bedrooms.D Pubiio/Commercial - Describe UseD State Owned - Describe UsePhone NumberLoiHT_4L'A■AI, Section(circle one)__^^N; R *7JSBlock «Subdivision NameT\ 6eft. CI\TCSM Number□ City ofD Village ofBsTownof ftourtA LaKcIII. Type of Permit: (Check only one box on line A. Complete line B if applicable)A."H New SystemD Replacement SystemD ircaiment/lloldingTank Replacement OnlyD Odicr Modification to Hxisting System (explain)B.D Permit RenewalBefore RxpiratlonD Permit RevisionD Change ofPlumhcrIV. Type of POWTS Systcm/Component/Devlce: (Check all that applyD Permit Transfer to NewOwnerList Previous Permit Number and Dale IssuedIS Non-Prcssuri/ed In-Ground □ Prcssuri/cd In-Ground □ At-Oradc □ Mound > 24 in. of suitable soil □ Mound < 24 in, ofsuitable soil□ Holding l ank □ Oilier Dispersal Component (explain) □ Prctrealmeni Device (explain)V. Dispersal/Treatment Area Information: bk Q»j.'c.3c44 p),js Ckec<wb«r» lwOK IDiDiSDesign f-low (gpd)300Design Soil Application Rate(gpdsOo.yspersal Area Required (sf)VI. Tank InfoSeptic Of ttolding TankCapacity inGallonsNew I anks'7S'0lixIslinK TnnksTotalGallons(/ofUnitsspersal Area Proposed (sO^ManufacturerUO'ig^e r ^onc rel-g-ystem Llcvation90.as".c H,ca uu'IHi'o: oDosing CbaniberVn. Responsibility Statement- 1, the undersigned, assume responsibility furinstalliliun nfthc POWTS shown on the attached plans.Plumber's Name (Prim) Plumber's Signuture MP/MPR.S Number Business Phone Numbererr IPlumber's Address (Sueei, Cily. State, Zip Code) / ^ /Plumber's Address (Sueei, City. State, Zip Code) 7 ' ^'7J6'-6*S'6-6H7^.£?To>V<. ^7 Ha'/wascA i tOXVJIkCounty/Departmcnt Use Only^.r. -D DisapprovedD Owner Given Reason for DenialPermit Fee$Date IssuedIssuing Agent SignatureIX. Conditions of Approval/Reasons for DisapprovalAttach to complete plaai for the system and submit to the Couniy only on paper not less than 8 1/2 aSBD-6398(R. 08/14)^0^ PAGE 1 OF 4Pg 1 of 4Pg2of4Pg3of4Pg 4 of 4In-Ground Gravity PlanIndex & Cover SheetComponent Manual Design References:Version 2.0, SBD-10705-P (N.01/01, R. 10/12)Index & Cover SheetPlot PlanDispersal Area Cross-Section & Plan ViewManagement PlanAttachments:Enclosures:POWTS Application for ReviewSoil Evaluation Report & Site MapProject Name / DescriptionDamon - Loon Bay LnOwner Name(s): Patrick A & Kari A Damon Phone:Owner Address: 108 W Kohler St; Sun Prairie, Wl zip: 53590Project Address: 11119N Loon Bay LnGovt. Lot: 1/4 of 1/4, Section 5 T 41 n-R 7 EDor W 0Township: Round LakeCountv: SawyerProject Parcel ID #: 024-175-00 1500Designer InformationDesigner Name: Ronald A Spreckels Jr Phone: 715 .558 .6472Designer Address: 9205N State Road 27; Hayward,E.mail: ronspreckels@yahoo.comWl_ Zip: 54843This space reserved for approvLicense Number: 226688Remarks:al stamp.Signature:/ Onginal signatiite reqpif^ on eareqfrif^ on each submitted copy.Date: / /fe/Ao Plot PlpnnJPi»pe«cdwellSCALE-MOUW'^r'J Loo«v» ^Lot is TifrBtucm su&o.Touirt o< UoiV^Sawyer Coo^V^?e,\. /ffOOBlA-c Me».;\ w| 9»'«S>oar\ 1*1 IS" Map \cE" L e\;aT\otosBtAs loo-OofLa\ » ^ H. :>5- f-Le»^-- *\'k. as HC)i» 'JS.ooP^ST- T^lO^aX Cfly,c««itf S«pVtc4c«\l(U>»'<4er Comet It. <w|Ut^tnF«e UTJ/s ie>'l4<r'Nftr AlofifrrpVioo fitrea C0na:«'|..v«^ o/©AC ©e/l ecm4<^iofo^fiWcfcV Plv^ Ciuifmber-^ IN-GROUND GRAVITY DISPERSAL AREAUniform Elevation Trenches with Quick4 Standard-W Chambers3-ft Trench (down-sizing credit)Septic Tank(s) ManufacturerWieser Concrete IncSeptic Tanl<(s) Volume(s>:Effluent Filter ManufacturerLifetime Filter LLCEffluent Filter Model#; LT-1/8SOIL COVER• min. 1?(typical)irmin. trenchdepth(typical)— it' —(typical)Pf'PICAL TRENCHCROSS SECTION VIEW(No Scale)Quick4 Standard-Ww/ End Cap.— (typical)System Elevation - 90-25(typical)(Show location of inlet / outlet pipe connection on plan view.)Provide minimum 3 ftseparatbn between trenches.Observation Pt>e(typical)Install per manirfactisef's/ instructions.I A = 3.0 ft(tyf^l)TYPICAL TRENCHPLAN VIEW(No Scale)(typical)INSTALL PER TRENCH:Quick4 Std-W (@ 20 EISA/chamber = A40_ Pairs of end caps (@ 6 EISA/pair = 5= Proposed EISA per trench =^Quick4 Standard-W Chamber(typical)(mftJ by Infiltrator Systems, Inc.)InstaB pursuant to manufacturer's instnjcllons.ft^ Required infiltration Area = ft'trenches = Proposed Total EISA = 445Distribution Method: PAGE 4 OF 4In-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 Malntainer inaccordance with SPS 383.52 (3), Wise. Admin. Code.Maximum Dispersal Area Operating Limits;Design Flow = 30Q gpd; BODs ^ 220 mgL ^ TSS S150 mgL ^ FOG ^ 30 mgf^Inspection Checklist INSPECT EVERY 3 YEARSo type of useo age of systemo nuisance factors {i.e. odors, user compiaints, etc.)o mechanicai maifunction {i.e., pumps, valves, svirftches, floats, etc.)o material fatigue {i.e., leaks, breaks, corrosion, etc.)o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution I drop boxes)o neglect or improper use {i.e., exceeding design capacities, prohibited activities, etc.)o extent of ponding in distribution cell prior to dosingo dosing irregularities - if applicable {i.e., pump re-cycling, float switch settings, ete.)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 NR113, Wise. Admin. Code.o Effluent flltertsi shall be inspected every 3 years and shall be cleaned when necessary to remove anyaccumulated solids according to manufacturer's specifications. A servidng period will always tie 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 hillure or maifunction to:Name of individual or company: A SpreckBiS Jr Phone: 715-558-6472Local govemment unit: Sawyer Coupty Zoning & Conservation phone: 715-634-8288Local govemment unit address: 10610 Main St, Suite 49 , Hayward, Wl 2IP: 54843Any 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.