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HomeMy WebLinkAbout026-939-14-5224-SAN-2020-066Industry Scnices Division4822 Madison Yards Way 53705PO Box 7162^Madison. Wl 53705-7162^ST po 02o'\County$Sanitary Pennii Number (to be filled in by Co.)Of ^98^ISanitary Permit ApplicationIn accordiinco willi SI'S 383.21(2). Wis. Adm. Code, siibniissioii ol'iliis fomi to die appropriate govcmincnial unitis required prior to oliUiining a sanitary peniiit. Note: Appliealioii lomis for sliile-ouncd ["OWTS arc suhmilled tothe Depanmcnt ol'Sal'ely and Proressioiiiil Semes. Personal iiirorinaiion you provide may be used lor secondarypurposes in accordaiiec willi lite Priviiey I ,au, s. 11 Km), Sials.State Plan Review NumberPWTS - —-C1. Application Information - Flense Print All InfornitttionProject Address (irdilTerent than mailing address)\Ohr\Vs-Pi'bhPropenv Owner's NamePartx:! HProperly (Jwner's Mailing AddressI32s^ Sol/th-OiCr- - ;V- S22</Property LoeiilionCiiv. StateZip CodeII. Type of Building (check all that apply)or 2 lamily Dwelling-Number of BedroomsD Publie/Coinmcrcia! - Describe UseD State Owned - Describe UseM-Govt. Lot 2.Phone NumberIxit U_'/>. Section—i/o /1/S (eircie one)3y N. R U9 Z o^W3Subdivision NameBlock #CSM Number£^2.^\foL.n ?c, 9,^□ City of□ Village of."^l^own ofIII. Type of Permit: (Check only one box on line A. Complete line B if applicable)New .SystemD Replaccmcni -SystemD Treatmcm/I lolding Tank Kepiacentem OnlyD Other Modilicalion to Lxisiing System (explain)B.D Permit RenewalBetbre KxpiraiionD Permit RevisionD Clianac of PlumberD Permit Transfer to NewOwnerList Previous Permit Number and Date IssuedrIV. T VDC of POWTS Systcm/Component/Dcvice: (Check all that annly)^j^Non-l'ressurl/cd In-Ground D Pressurised In-Oroiind Q Al-Grade Q Mound > 24 in. of suitable soil D Mound < 24 in. of suitable soilD HoldingTank □ Other Dispersal Component (explaini D i'relreaimcnt Device (explain)V. Disiiersal/Trentment Area Information:Desien ITow (apd)Vl.^^nk InfoDesign Snil Application Kate(a>dsr)•Dispersal Area Required (si)JOooDispersal Area Proposed (sljSystem BlevationCaptieily inCiallnnsNew laiikiLvisling TanksI'cmilGallons# ofUnitsMaruiUielurcr£, S■5 Sa S£ uM S40 ajiiOS<plic or Holding Tank12^I2S0Ujyt75<^Dosiiiy C'hnmberVII. Responsibility Statement- I. the undersigned, assunit responsibility fur insiaiiaiion of the POWTS shown on the attached plans.Plumber's Name (Print)Plumber's Address (Street, City. Slate. Zip Code)P umber s SiiziuhtITcMP/MO(S-Numbcr/-S722Huslness Phone NumberVlll. Coiinty/Dcpartment Use Only0Ap:n DisapprovedD Owner Given Reason for DenialPermit l-'eeDate IssuedIssuing Agent .SignatureIX. Conditions of Approval/Reasons for DisapproviiiORIGINALMAY 0 H 2020Attach to complete plans for the system and submit to the County only on paper not less than 8 ni a II inchesNO REFUNDS AFTERISSUE OF PERMITSBI)-63';8(R. 04/m)SAWYER COUNTYZONING ADIUllNlSTRATION CONVENTIONAL IN-GROUND POWTS DESIGNResldeutifll ApplicationIndex and Title pageOwner's name:Owner's address:Site Address:Legal Description:Town:County:Subdivision Name;UL -3: CeI3ZS9 FfeTvy/vrsV,^ AuL, ScUTVSnuftdr. /VIaJ.LdHiti^Pism X/Siutr ^AJ. tfC/Tk:^• nLot No.Block No.Parcel Idratification Number:; 026 - ^39- - SZzQPageLidexPage 1 Index and TitlePage 2 Plot Plan (May include septic tank and filter specs)Page 3 Distribution Cell(s) Cross SectionPage 4 Maintenance, Management and Contingency PlansPlumber Name;Plumber Address:Signature:Date;_CredentialNo. ISZ'Z-Pmh^Uttna j,]!:A/z /. Phone No. Ci3 V •• 3S^~FDesigned Pursuant to the;In-ground Soil Absorption Manuel for POWTS Version 2.0 SBD-I0705-P (N.OI/01)Page 1 of o ii LU -J cC O U1 3 eO ts 4 d 3*tf- J I *1 I' ¨ e 7 7 ll)c Y lO *1 I r <*V- 3 « J (t •o - 2 It T t- s5 C 0 f*O <A '.8 (L O <n c • J a z £ W> b 0 5- rt lo IT «0 «r k 1 o 0 0. c 0 <£ */ - C 3 iC Z CC *• 1 I/) 2 C l- £ P lU J U] -v ** 0 0 0 0 c CO <-ir O'' C ft <r o to <r n (9 0 0 lo «1 0 _w ro co O oo •o ,1 (f t: I- o SoilProfileSheet '(S q-7 % 95 9i • ^2 * <?o S7- g6" 2as!sSevi___. sonrtsu,: System Elcvation:___ Load Rate; O.0> f n n 65. Tr. Syitem Range:^ to <fac8 5 1-S' > 7^ . cC. N,f. -<?5.33 j A' .f. +3' ^ . St.9/ ' -9s:c>' -^333 $ I iH3 V -90.33 ^Quick4STANDARD CHAMBER52V..Quick4 Standard Chamber12-I ;• /34*SECTION VlbVVlEFFECTlVE LENGTH)SIOK VIEWMultiPort End Cap^ Rcuis 0 F / 712-'..j \ cu. £~ - .. — 34- --FRONI VibWSIDE VIEWTOP VIEWSize(W.xlxH).; •• ' •34'x52''Xi2*Effective Lenoth48"Invert Height . ,8'MultiPort End Cap Nominal Spe^M»onsSl2e(WxLxH) ' ...... •Inven Height _ ' g' or1.25"INFILTPATOR SYSTEMS. (NC.SJANDAB.0.1.IMltEPJYAaBMT.Y►i is. ti IvrwiBi-,rti (Viif fvnti' & v« Oib .4s*e vyu««nrii<ja«g tk»/*•*•••-''kV'a -rtn .V s/tMr. nvm.rn'v'ikm' Vf43 fT ^.rJf*.% Oi.fuMir* «r»a.' iiW. i«Micr .i *♦.-.« g at f. On»*el',' KO*-*1«» *i CU SsiCvtm. Cty*»«cW»i wVsi • M►•''.•als*'«*• »«•» »* •>»*% A<^Tr**<iev a ic-l* a»«aJBrF»kUf«eaJNSt*T«ir#?• M«*» «»% 9«* rt i»/T».v< at><* r ^ av trer,tk nfc ifiPft*.' iV/jatA.v!- ij. ah i»«R: Afxt M'^oIhlhWAjevAMics ta-ii rt'p T*t iwir. mtB«r, o/injEcWAfs^k.v»:»r-uf a<« iu-- Ft a wiirsia»u\a^ri.1 h* Ui*»*i 1, i r») ^-•l • .tit, i%wi y <s ^ r. r> .«naj* 7^• t«li«« l i n».») W»nat, j.r.• < iM.At M'14 tW MA-«H ■# aoMflivl iie.kyeri 44i.4».j I'., .tIViaa^WT fct'.ft ., Ua" .1.1 rw*««» t'Qm »r..-c i« ltjr.r^ e« fm i»iv 1*in1 IWV Sii^er »»4IMJ acia I•rt« *•n] a, •Afxp v« tn .«s <kM l<« v4«»iWY t»» ««aki« »«a<k«. atnre* r«v" 1I J#»g ut^.T,it M p.iffc .• .\4•V. M<At. VII n.t |Min4r4<t t** fra rwlrfiiwi /»»»<>rrw l.^ni <•••t«Ham. t" »••**" trunj vt \4tft «i B■. Frjjincn 41,:' j-n*v. {m* n #»*r«n iny,*ws re* *•» rr«**'>«•• t>>1-I>1^.4 tf«wtAv#-wr. lAn t.i fiT4n»*4 rrfmc* -x'jvj nrnf#* ^fire .* irqceef ,«sAM. I'Xrw MdvtM«.' •*• >•..•• •••- — tti|«.4M .A4*4ls>i Ar»l u •Wintty THs L4%y<Al W.er*.t. ..'.rf rc. .<•t if Qv »»AA* liiA. ci irvrt*^ MO. .< 0r. f.*it». *4 v.tn •< nw, \ i»uMf« wfn»fc> tt,HM »*r-aw ut .wiy nwUMTr'ti*suW»j*<«iiaLi^«liv.i< jtaii'mS ;■ Si»*T jr.f cm.X#.( Aat#» f «y |ieti^a i* af».. ^»fi ^>fty rc» ihb tjnhiJ W«t.«-4v «»iVpV P* nu*^ '•» #* 1wttn •-CiAl v.nal sif.* ;«A'JtA-t»Ars *.;*ia!tai.»:.rTcli.4«r«i mtnftJm.INFILTRATORSYSTEMS INCEnv/ronmenfaf Onsite Wastenirief Solutions''(i Biisiimsr. Paik FToTti • P.O. Box 768Old Soybrook, GT 0647ft«(jO-577-7000 • PAX 860-577-7001800-221-4436©• ..• .•mi.n.i ITO".. ff'lUfrt'.dwr "•■»•>. OKlrUi.I ....,.■..■u(u«.~..-..i.Bi.»l,..ii„l',r.l.-JW..r,..v.n.v..ih, i ••«.. ...i.x .if ..u,,. j.i ri.n.. a».i.u9UJ.1 I ..lliVJ rfflnB.. ..ly '4. ). l..ir.lV. .•O i''1'y>.ipL»-JO......»T4'lN VKl I/.44I Mtf....#, .Ml IMT «,.(j.f, .... ... Ihr ll.'.y.... iJ !*«•.U> I»ul«-,1S 4./r!i..[^l. S,0t7,fVll. :.,33r,,ai7'.v4l)l,llh:0,^i.l,.IW:r,,!;i1.U(XV5 'If. IKI •,'.»! 77»-'.n;H'iB-wr.«wiiv, P,ii|.i,f. 1,.CT1.I#!;U; :,PCW,M11 0:l»'r.i1.i"!si«.Mir.j FILE INFORMATIONPOWTS OWNER'S MANUAL & MANAGEMENT PLANSYSTEM SPECIFICATIONSPage..of.OwnerPermitDESIGN PARAMETERSNumber of Bedrooms□ NANumber of Public Facility Units□ NAEstimated (average) Flow-Voo(gal/day)Design (peak) Flow = (estimated x 1.5)(gat/day)In Situ Soil Application Rate(gal/day/ft')Standard (Domestic) Influent/EffluentMonthly averageFats, on & Grease (FOG)Biochemical Oxygen Demand (BODs)Total Suspended Solids (TSS)£30 mg/Ls220 mg/Ls150 mg/L□ NAHigh Strength Influent/EffluentMonthly average(FOG)(BODs)(TSS)>30 mg/L>220 mg/L>150 mg/LPretreated EffluentMonthly average(BODi)(TSS)Fecal Conform (geometric mean)s30 mg/L£30 mg/L£10'Maximum Effluent Particle SizeHin dia.□ NAOther:□ NATank Manufacturer;□ NA"^^^^eptic □ Dose □ HoldingVolume: j 2 STi(gal)Tank Manufacturer:□ Septic □ Dose □ HoldingVolume:(gaOVertical Distance Tank Bottom(s) to Service Pad:(ft)Horizontal Distance Tank(s) to Service Pad:(ft)specific servicing mechanics must be provided If venical is >15 feel orIf horizontal is >150 feet. Specific Inslnjctions to be provided on back.Effluent Filter Manufacturer:Effluent Filter Model:CcCU□ NAPump Manufacturer:Pump Model:]>^NAPretreatment UnitManufacturerD Mechanical AerationG Disinfection□ Sand/Gravel Filler□ Peal Filter□ WeUand□ Other;Soil Absorption System'^In-Ground (gravity)□ Al-Grade□ Dflp-Une□ In-Grourtd (pressure)□ Mound□ other;□ NAOther:□ NAMAINTENANCE SCHEDULEService EventService FrequencyPump out contents of tank(s)□ When combined sludge and scum equals one-third ()S) of tank volume□ When the high water alarm is activatedInspect condition of tank(s)At least once every;□ month(s)□ year(s)(Maximum 3 years)□ NAInspect dispersal cell(s)At least once every:□ month(s)□ year(s)(Maximum 3 years)□ NAClean effluent filterAt least once every:□ monlh(s)^ yeaf(5)□ NAInspect pump, pump controls & alarmAt least once every:□ monlh(s)□ yeaf(s)□ NAFlush laterals and pressure testAt least once every:□ mohth(s)□ yearfs)□ NAOther:At least once every:□ monthfs)□ yearfs)□ NAOther:□ NAMAINTENANCE INSTRUCTIONSInspections of tanks and soil absorption systems sliall be made by an individual carrying one of the foliowing licenses or certifications'Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper).Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify 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. The soilabsorption system shall be visually inspected to check the effluent levels In the observation pipes and to check for any ponding of effluenton the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediatenotification of the local regulatory authority.When the combined accumulation of sludge and scum in any treatinent tank equals one-third (H) or more of the tank volume, the entirecontents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113Wisconsin Administrative Code,All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components pretreatment unitsand any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer,A service report shall be provided to the local regulatory authority within 30 days of completion of any ser\nce event.GMW-OOS (02/05) START UP AND OPERATION °'-For new construction, prior to use of the POWTS cSieck trratment tank(s) for the presence of painting products, solvents or otherchemicals or sediment that may impede the treatment proems and/or damage the soil absorption system. If high concentraUons aredetected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use.Pump tanks may fill above normal highvrater levels prior to startup or due to pump failures. Start up or restoration of power under theseconditions is not recommended, as the excess wastewater wit! be discharged to the soil absorption system in one large dose causing anoverload that may result In the backup or surface discharge of effluent and damage to the system. To avoid this situation have thecontents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or cwrtact a PlumberOf POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank.System start up shall not occur when soil conditions are frozen at the infiltrative surface.Do not dnve or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact, thearea within 15 feet down slope of any mound or at-grade soil absorption area.Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the treatmenttanks and soil absorption system: adds, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss,diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meatSCTaps, medications, oils, painting products, pestiddes, sanitary napkins, solvents, tampons, and water softener brine discharge.ABANDONMENTWhen the POWTS fails and/or is pwmanenlly taken out of service the following steps shall be taken to insure that the system Is propertyand safely abandoned in compliance with s. Comm 83.33, Wisconsin Administrative Code:• All piping to tanks, prts and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed.• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servidng Operator (pumper),• After pumpflng, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soilgraval or another inert solid material.CONTINGENCY PUNIf the POWTS fails and cannot be repaired the fbllov^ng measures have been, or must be taken, to provide a code comoliantreplacement system:□ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systemThe replacement area should be protected from disturbance and compaction and should net be infringed upon by requiredsetbacks from existing and proposed structure, lot lines and wells. Failure to protect the r^lacement area will result in the needfor a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules ineffect at the time of their permit issuance.A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot berehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort.The sits has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluationmust be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as alast resort to replace the failed POWTS,□WARNINGMound and at-grade soil absorption systems may be reconstructed in place fc^lowng removal of the biomat at the infiltrativesurface. Reconstructions of such systems must comply vrtth the rules In effect at that time.TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS QASSES OR UCK,-fL SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAYRESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE.ADDITIONAL INSTRUCTIONS;POWTS INSTALLER POWTS MAINTAINERNamePhoneNamePhoneSEPTAGE SERVICING OPERATOR (PUMPER)NamePhone7Z79LOCAL REGULATORY AUTHORITYNamePhoneThis dwument was draftefl by the staffs of the Green Lake, Marquatte and Waushara County POWTS regulatory aoendes In compliance wrth sectionsComm 83.22(2)(b)(i)(d)S(f) arid 83.54(1), (2) & (3), Wisconsin Administrative Code.