HomeMy WebLinkAbout014-942-29-1103-SAN-2022-038 �� " l;, IndusUy Services Division �au��Y
4822 Madison Yards WaY �L(,j,�' �
�= �iSp - Madison,WI 53705 Sanitary pem�it Numb to be filled in by Co.) �
_ :' P.O.Box 7162
�::� _�� Madison,WI 53707-7I62 �3 L}o�S
Sanitary Permit Application S�e Transaction Number
�
In accordance with SPS 383.21(2},�s�Adm.Code,submission ofthis form to the appropriate govertunental imit
is required prior to obtaming a sanitary permi�Note:ApplicaYion forms for state�owned POWTS are submitted to Project Add�ess(if difte�ent than mailing addcess) (�
tfie Depaxtr��t of 3afety and Professional Services_Personal information you provide may be used for secondary 1��(l��(� C'��y�� ��T p�
pucpases in accorda�c with the Privaz,y Law,s.15.04(1}(m),Stau_ '� v I
I.Appiication Iniormation-Piease Print All Information �(',�LQ'
Propecty Owner's Name Parcel#
, t aiy-qY,2 •�4-� 1�3�
. _
Property owner s ailing P�operty Location
� � � � �
City,State "Lip Code Phone Number Af[�
�r _ l�1 1�� y,, +v l� '/., Section�
�,y ��i
II.Tyge of Building(check aII that appty) Lot� T N R E or -
�I or 2 Family Dwellmg-Number ofBedrooms_�_ "— 5ubdivision Name
�.��
Block#
�ubiic/Commerciat-Descn�be Use .�
ity of
❑S�ate Owned-Descnbe Use CSM Number illage of
�Town of ��-f�-f Cl�'
III.Type of POR'TS Permir(Check either"New"or"Repiacemenf"and other applicable on line A. Check one boa on liue B.Complete line C if
a licable.
A' ❑New 3ystera ' �eplacement System �Other Modification to Existing System(exgtain) Additional Pretceatrnent L'nit(explain)
tir.s
-'" 1-3'G
B' ❑F[oldi�Tank �In1'iround �4t-Grade �Mound Individual Site Design Other Type(explain)
(conventional)
C- ❑R�cwa!Before �Revision nge of P(umber �fransfer to Ne�v Owner ist Pre��ious Pesmit Nnmber and Date Lssued
�� `� � - o-?� 6 6
IV.IlesperssUl'reatment Area and Tank Iafarmatioe:
Desig¢I�1ow(gpd) Design Soil Application Ratel�pd/sf} IJispersal Area Itequired(s� Disge�sal �4epesqi�s� System Eievation �
`� Y2 Sd � �' �
Capacity m Totat �of Manufactnrer
T��fa�d� Gailons Gallons Units p � o� �
Nc�r Tanls Exisiing Taoks � c � L y �� �
0
a U ii� �, �n w C7 p.�
Septic�}iaWing T�)c �7,,,j � � � I Wf I � �
!`1
Dosaig Cbamber � � �
V.Respousibility Statement-I,tLe oadersigned,ascame respoBs"sb�7itg fer instafiation of tLe POWTS shoven ea t#e attacLed planc.
Plumber's Name(Prirrt) Plum re MP/MPRS N�ber Business Phone Number
-� ✓ ��. ��l �/�-����_ -1�-.
r�u s naa�csc�t c�ty,s�,z�c�)
e ��'!/� ��1,t-'�1. �=f��>�iz� �Ce/l�f�. l �� t�%':— ��C �' 3
VI.County/Department use oniy
� ��ro� Permit Fee Date Issued Ls�ing Agent Signature
�� ❑Owner Giv�Reason for Qeniat � f��•� �/y/°��
1 r...�.....� .-;r-•r=��
Condidons of ApprovatJReasons for Disappmval �r:�,r, . i,,:, `�.;f _-'
� ., � �
�' ����`���a�, -�-�-0 6 2021
�+ ',�� � � __��..: _�------� DEC 4-
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C1 ST o2a—D�'�v SqWYER COUNTY �L� �,
DMINISTRATIOt� — �_—� �
' Attaeh to coroplete plans for the system aad submit to the CoupYno��t�Y'��12 z 11 inches ��� � � ����
IYC�
ISSUE OF PERMI7 `�
SBD-6398(R,03/21) - SA�E� �p�NTY
--.�•.�„�� rnnn�nllSTRAT�O�'�R
PAGE 1 OF 4
In-Ground Gravity Plan .
Index & Cover Sheet
Component Manual Design References: �
Version 2.0, SBD-10705-P (N.01/01, R. 10/12)
Pg 1 of 4 index & Cover Sheet
Pg 2 of 4 Plot Plan
Pg 3 of 4 Dispersal Area Cross-Section & Plan View
Pg 4 of 4 Management Plan
Attachments: Enclosures:
--____ -- —___-- --__ __ ___ _ __ _
POWTS Application for Review
� Soil Evaluation Report & Site Map
Project Name / Description
Owner Name(s): � �f-t7) �� Phone: - -
Owner Address:o2e�� �{: /�/yt./�/ Zip: �j��7�'
Project Address: ��l
Govt. Lot: 1`�r— 1/4 of N� 1/4, Section��, T �a"�N-R � E a or W �
Township: ���'00-}' County: ��tJ��.fi'
Project Parcel ID #: (�{� ' ��laZ" c�g" !�03
Designer Information
Designer Name: �(�t,/'►, �ji'�,/� Phone: �� �-�(07,3
Designer Address: ��?�N �OI�T11��;I►'I�;(�[rS-fj-�Q PCty�,�__ Zip: 5 �,�t���
E-mail: �Gc7�, u3.� ,
License Nun�ber: ���� � �j�
I '-}l� �� �J �
Remarks: ; f D
�`--.�' JAN 2 8 2022
SAWYER COU{dTY
ZONING ADAi1tNISTRATI0N1
�
Signature: Date: �`r����
�riginal signature required on each submitted copy.
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, � I N-G RO U N D G RAV I TY D I S P E RSAL AR EA Septic Tank(s) Manufacturer:
w:�S�r—
Uniform Elevation Trenches with Washed Aggregate
Septic Tank(s)Volume(s):
�S� gal gal gal gal
Effluent,�ilter Mar�facturer
,y5�'o'T`...a y�2
luent Fitter Modei#:
I q^fD
Geotextile Perforated Lateral min.12" Effluent Filter Model#:
Cover� (tyPical) (tyPical)
, SOIL COVER
, I �
�2" 0.5"TO 2.5"WASHED AGGREGATE
min.trench I � � ' (min.6.0"beneath distribution pipe
depth � _ -min.2.0"over distribution pipe and
(rypical) / ' '' covered with approved synthetic fabric)
� . :
System Elevation = � ��� ft. ''
TYPICAL TRENCH (typical) OBSERVATION PIPE DETAIL
, CROSS SECTION VIEW (NoScale)
(N �+ Screw-Type or •�,��,. Finished Grade
� J(�,aIQ) Slip Cap(loose) W- (mulched&seeded)
Provide minimum 3 ft
separation between trenches. 4°0 PVC Pipe Topsoii Cover
Top of pipe to terminate (min.1 foot)
at or above finished grade
� (4)1/4"-1/2"X 6"Slpis
� (Show location of inlet/outlet pipe connection on plan view.) @ 90 apart
TYPICAL TRENCH
Anchonng Device Intiltration
PLAN VIEW 4,. � • Surface
(No Scale) Perforated Lateral
(typIC81) Observation Pipe ft
, — (center lateral in trench) (typical) (typical)
� r� � �i �
— — — — — — — — — — — — — — — — — — — — — —
� - - - - - - �� — � — �
� ------------------------- � A— �� ft �
--------------------------- —
, o m
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�" - B - � ft - -� O
(typical) �
�_ S�-.N R 1 - o?(p �
Distribution Method:
Required Infiltration Area= ��_ ftz dt � ����
_ I �� �( � �� - So z
Proposed Total Infiltration Area - x o2 �eh�e� - ( ft
- - - - - - �CC�T - - -
PAGE40F4
In-ground Gravity Management Plan :
IMPORTANT: .
The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to
requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall
be 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 in
accordance with SPS 383.52 (3),Wisc.Admin. Code.
Maximum Dispersal Area Operatinq Limits:
Design Flow= �� gpd; BODS<_ 220 mgL"'; TSS <_ 150 mgL"'; -'
���, I
Ins ection Checklist INSPECT EVERY 3 YEARS � �'`-^J i�
p � �
o type of use
o age of system JAN 2 8 ZU22
o nuisance factors (i.e. odors, user complaints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) gqWYER COUNTY
o material fatigue (i.e., leaks, breaks, corrosion, efc.) Z�q,�qpMINISTRATiON
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, etc.)
o extent of ponding in distribution cell prior to dosing
o dosing irregularities- if applicable (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 ptugging (measure lateral distal pressure—compare to design specification)
o surface discharge of effluent or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
^ Septic and dose tank(sl 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 liqufd volume of the tank(s) or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113,Wisc. Admin. Code.
� Effluent filter(sl shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12
months.
System maintenance reports shaH be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component fallure or malfunction to:
Name of individual or company:��h- _ Phone:��� ���
Local government unit: �.(��,(/W�7u Phone: �����5�'r Oo7�
Local government unit address:��[�l.n��c�Gtd1(e�f(�G�C� ZIP: rj �(,�3
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1),Wisc. Admin.
Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383,Wisc. Admin. Code.
No product for chemical or physical restoration of the POWTS may be used unless approved by the department in
accordance with SPS 384,Wisc. Admin. Code.
Continqencv Plan
In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to
a plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be
abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils.
System Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33,Wisc. Admin. Code.