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S3�-o3S8;'�c�3:�, ISSUE OF PERMIT
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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): �� Lc��,� L LC, Phone: 60Z - �fl� - 634 1
Owner Address:lo56� N �'�c'�e.� �; �� (�� �{c�.��.c)ar� t,�l Zip: S 4 S`{3
ProjectAddress: �,v� 6c-od; L.r�-e..
Govt. Lot: 1/4 of 1/4, Section a4 , T 4 0 N-R Cf' E 0 or W �
Township: Q�GsS l..a���P County: S4.w -er'
Project Parcel ID #: UOZ -- Z� $ —DD -bZpo
Designer Information
Designer Name: RO� L.�- b4rt'P Phone: �cS - b tmt - 4 l � �
Designer Address: (�f�`�5 � S� �w�� ��yward l.� � Zip: S`�8�f 3
E-maiL• , _.
License Number: Z--Z(o 2..1 �
Remarks:
Signature: �o� � � Date: �3 zo2�.
Original signature required on each submitted copy.
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IN-GROUND GRAVITY DISPERSAL AREA SepllcTank(s)Manu(acturer�
LV � e se,—
Stepped Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down-sizing credit) Septic Tank(s)Volume(s):
'��Ugal gal gal gal
�__ Eftluent Fflter Manu(acturer:
I r �
SOIL COVER � �a-zy- °-O C'
- --min.12„
(Nplcaq [/fluent Fllter Mcxfel ft: S Z�
12" -
min.lrench
TYPICAL TRENCH deplh — •
CROSS SECTION VIEW �"��°a�' �
' _ —. __._.__. _.._.._..___ .e•. �
a a: Provide minimum 3 ft
(No Scale) f_— 3a^ ` „ � a � • separation hotween trenches.
(�YPlcal) .d ' . , .
, . a,. . Q.
a
f-lighest Trench - - - Lowest Trench(as applic�ble)
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System Elevations= �3 ft; �3 ft; ft; ft; ft
Quick4 5tandard-W
w/End Cap ObservallonPlpn TYPICAL TRENCH
(typir.al) (Show location of inlet/outlet pipe connection on plan view.) (typlcal)
Install per manutaclurors PLAN VIEW
' Instrur,Uons.
(No Scale)
� � -- -- - - - - - - - - �j� - - -- __ _-- -- — /f- --- - - -���� - - - - - - �
(� ; , , .� �.I �A= 3.0f1
, ' ` ` ' !) ' : ; ; �typlcal) �
�--'— - -'— -- -- -y -- - - - �/�- - - - - - --- -- -��- - - - - - - - - -- -� �
�-.-- - -- B = -1 O ft ------- —=� �
� rn
(typlcal) Quick4 Standard-W Chamber W
INSTALL PER TRENCH: (typical) Q
(mfd by Inflllrator Systems,Inc.) -�
Inslall pursuant to manufaclurer's inslructions.
�� Quick4 Std-W @ 20 f�E1SA/chamber= 3�n ft2 "P
+ ,� Pairs of end caps @ 6 ftz EISA/pair= � ft2
= Proposed EISA per trench= 3 S� ftT Required Infiltration Area= �H3 ft` Distribution Method:
x Z— trenches = Proposed Total EISA = � ftZ q rc�� � �
. Gq � .
PAG E �0 F �
{n-g�ound �ravity Managem�nt Plan
IMPORTANT:
The owner of:his ir:-ground graviy system snal! be responsible fcr its perpetual operation and maintenance pursuant to
requiremeris of SPS 382-384,Wisc.Admin. Code. Pursuant to SPS 383.52(2),Wisc. Admin. Code: this system shali
be considered a human health hazard i�not maintained in accordance with this anproved management plan.
Fur�hermore, aii inspection and maintenance activities shali be performed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3),Wisc. Admin. Code.
Maximum Disqersal Area Operati�q Limifs:
Design Flow= �'S� gpci; 30�5<_220 mgL''; TSS � 150 rrtgL"'; FOG <_30 mgl."'
' (nspection Checklist �NSPECT EVERY 3 YEAi�S
o type of use
o age of system
c nuis�nce�a�iors (r.e. edors. user�orpiaints, etc.)
o mech2r.ic2! maifunctio^ (i.e., pumps;vaives; switches,7oats, etc.)
o maierial raiigue (i.e., ieaks, breaks, corrosion; erc.)
o solids vaiume in anaerobic treatmert tank(s) and any distribution appurtenance(s) (i.e.,distribution/drop boxes)
o neglect or improper use (i.e., exceeding design capacities, prohibited acfR�ities, etc.)
o extent of oonding in distribution cel! prior tc dosing
c dosing irregu!arities-i*applicable ;Le.; pump re-cyci;ng,flaat switch settings, efc.)
o efectric2l compor.er,ts-if 2pplicahfe(i.e., wiring, connections, switches, controls, timers, afarms, etc.)
o distribution lateral or!ater2l orifice piugging (me2sure Iatera! dista( press�re—compare to design specification)
o surface discharge or e�f�uent or sewage back-up into structure served � .
Maintenance Checklist MAiN3Al�l EVERY 3 YEARS (or when necessary)
o Septic and dose tank;s)�'�!2i1 be pumped by a ce�:i�ed septage servicing operator licensed �nder s. 281.48 Wis.
Stats.when the volume of solids in the tank(s) exceeds one-thBrd(1/3)the liquid volume of the tank(s) or
as required by icc�l ardir.ance. Disposa! of contents sha11 be pursuant to NR 1'f3,Wisc.Admin. Code.
o Effluent filter(sl shall be irspected every 3 years and shall be cleaned when necessary ta remove any
accumul2ted solids accerCing tc man��iacturers speci ications. A servicing period will always be greater than 12
mcrths.
System maintenance reports shal! be subsni�ted te the proper Eoca!government unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any comportent tailure or ma[function to:
Name of individua!or comoany: �0 .6 (�c�. �ct.r�e� � � �q Phene: ��S —���— b� 3 �
Local goverrmeni ur.it: .S�l.�;��� �o �o✓i t v�.q P"one: ��S—63 4 _gZ.S S
Local Covernmen; unit address: i � �l� �1�,c�.�h S"�" � L-l�t ��-r w�r� Le,�«: S��s`t3
�
Any defective part o#this sys�em s�2!i be repaireC, replaced, or removed pursuar.t to SPS 383.51 (9),Wisc.Admin.
Code. Repair or replacemeni oT i2iied or rn21T�nctianing componerts shali ccmply witn SPS 383,Wisc.Admin. Code.
I�o preduct Ter ci-,emical or physicai restor2tion oT;ne POWTS may be used unless 2pproved by the deoartment in
accordance with SPS 384,Wisc. �dmin. Code.
Continaencv P9an
!n the event tnat any�ailed treairren:component cf�'r,is POWTS ca^not�e�epaired, it shalf be repfaced pursuant to
2 plar submitted to t'r,e approp�i2te agency ior review and 2porova. A failed in-g-aund .�.ispersal component may be
abandoned 2rd replaced by a coce-corp!yirg dispersai componer:�i:, a pre-dete�'s^e� area of suitable soils.
Svstem Abandonment
If use of this POWTS is discortinued, it shail be abandoned ir acccrdance witn SPS 383.33,Wisc. Admin. Code.
�°,�' "„E��r PRIVATE ONSITE WASTE TREATMENT co�nty
/ ��
r�/ ��'
���r asp ��� sYSTEnns Sawyer
�L�A��j ( POWTS)
�rs"—"V=`' INSPECTION REPORT Sanitary Permit No:
Safety and Buiidings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �����
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(I)(m)j
Permit Holder's Name: ❑City ❑ Village �Town of: State Plan Transaction ID#:
� (.�,�. �-c�- �ss �I,�..
insp BM Elev: BM Description: Parcei Tax No:
�o�.�' N9�c �-�`��,�, �«u nT .s;� i�'' � P� �2-a�--oo-oa�o
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic ��e�- �p� Benchmark pp,o�
Dosing
Aeration Bldg. Sewer 4s;Y$`
Holding St/Ht Inlet �t S.�3�
TANK SETBACK INFORMATION St/Ht Outlet 9 y,86 �
TANK TO P/L WELL BLDG vENr ro ROAD Dt Inlet
AIRINTAKE
Septic .�-�` ��� $` .�..g' NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. �Y,g '
Holding Dist. Pipe
PUMP I SIPHON INFORMATION Infiltrative ��,�g ,
Surface
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFOR ATION
DIMENSIONS W 3� � 6 #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate T�I .
P I L Bldg Well ❑ IGP � Chamber "'�
INFORMATION Waters � AG � EZFIow Model Number:
CELLTO 3�` ,�.3� ' ❑ Mound o Other Q�
-- — _ ___--
DISTRIBUTION SYSTEM X Pressure Systems Only
Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes
Length Dia Length Dia Spac Spacing ❑Yes ❑ No �
---- -
SOIL COVER
Depth Over Depth Over Depth of Seeded/Sodded Mulched
Cell Center _ _ Cell Edges Topsoil ___� ❑Yes ❑ No l ❑Yes ❑ N�
COMMENTS: (Include code discrepancies, persons present,etc.)
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Plan revision required?❑Yes❑ No �� ���3 - J � �'� �� �
f
Use other side for atlditional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3l01)
A�OITIONAL COMMENTS AN� SKETCH
SANITAAY PERMIT NUMBEA: � �--���p
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