HomeMy WebLinkAbout002-940-04-3114-SAN-2022-067 , � , � rtg � .�,
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� /�/.t��, � !ndustry Setvices Divis:on 54�v �-e � �
j ��t' Q . `�� ' '�00 c Was!-;ng.o;:�ve $ani+ary?emit Nu;�xr(to be fiiled in o
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� �2r�ta.ry �e�tt �pplication , ______ �
in accorda.ce w�th 5P5 38321(2?.W�s.Adm.Code,submission of this forrr.ro�he appropriaal.^gove^im�:ta!unit � J
is requi:ed pr:or w octaining a sar.i2y�errr.it. Nou:<.ppticztion fo.r.�s.`or sate-o���ed��`%�'?'S are subr..i:ted to ?ro;ut ndd:�s(ifdiffaen�than naiiing
the Deparcr.�enc of Safay ana?ro:asionai Servia. ?-rsonal'.,worsnaiion you provide,ma;+be used ior sronda:�+ �
au in ascorda.*see wich the?siv Lav:,s.!5.04(I m).Stau. � r0�� L�e..
i. A fltication informatioII-PEeasc P�ini All.nforrriation
' ProP�Y Dwner's 21ar.ie C���i�.1��, ;� parc:l r
R- g L��� LLC � f�(ju��z� Doz -4`fo -b4 -3 � 1`f
aropern�Owrs:r's?v�ailing Address ?ropercy ioczcon
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� �Ior2ramilyDweiiing-Numbero•`3edrooms � i 1. Subdi�isionName
� Blcck; �
❑Pubt iGCornmerciai-Desa';be Use ;
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?Ii.Type ofPersnii: (Cfuck oaiy one box an fine A. Complete liae B if appiicable} '
A I�New$ySi�m 0 Repfec,.�tr.�t Syst�n i Li Trear.neatlF�iaidiag Tuik Repiaeem:a,O:ziy j v Other Modincation to Existing Sys:em(expiain)
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$. r- -� ! List?revtous Permi:Number and Date Issued
❑?emit Renewal u?eanit Revision L Cnan�e ci?3umber ❑Pesmi;Trmsfer to New _
, Befora Fxpiration pwner
FV.T• of POWTS S m/Com eatlDevice: C6eck alt that a !
�Ivor.-Presserized in-C-rour�d U?rast;riud in-Groand i_i At-C-rade !J Mo•a.�>i4;�.of s::i�ble soi? ❑lviound<24 ir..of sui�bie soil
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v.Dis flTrsatiaent Arrs Fnforruatioa:
Desi�Fiow�{gpd) Desiga Soil Applicazian R2u(gpc�s:? � �isvC,Sa'A:��equired(� � I?isper52i Arta PrOpoSd{5� System Elevation �
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VII.Responsibilitv Staumeni-F,the uade�sigatd,as.sume respotu�itiry for iustaliatioa of the POwTS 5i36wD On SbC sEt8Ched p12tL5.
� Plur,.ber's Name{?ri,,t) ?lu;iber's 5i,. :ure M.D/MPRS Number 3usiness Pho�N�:mber
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VIIT. o a:v/De artmmt Use Onlv
�A� �a ❑ Dis2pproved , ?ermi:Fee i Dase Tssz.�ed : :ss��.g Rg�SignaEurt
�� �i.Owner Given ReaSon for Deaiai � � ��� 1 S ��{ (2�- ��il�Cl-� ./��r
IX.CoaditiousofAppmvsilReasonsforBisapproval �� ����
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ASlseh to coecpitie plaas for!ae sysle�and submit to She Cotmty Oai,'x papet a0f Eas lIIss S IRs l I iaehes ia.�WY�R CO U�1TY
ZONING ADMINISTRATi�t
Pl0 REFUNDS AFTER
S3D-63S8;'Ko3t�} �c,,�VE pF PERMIT
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
I
Project Name / Description
Owner Name(s): R Pi l�a�n, � �-�-C Phone: 6�-4az - 634 l
Owner Address: t b�'h 1 N �` $c�e,� I-�; �( �1 ('{�.� (.o�l Zip: S4 8 43
Project Address: c� h k� c'o c� � Ln e _
Govt. Lot: ��1/4 of Sw 1/4, Section�, T �f a N-R D�f E�or W�
Township: j�,c�Sf l..�a.�,L� County: S�w�e �--
Project Parcel ID #: 00 Z — �c�a -- 0 � -- 3 ( ( y-
Designer Information
Designer Name: �a b (,..� �� ,��-L Phone: -I i S -6�i�t - D`�-r 3(�,
Designer Address: l`f51 l v�l � � -7��l-E��►c�a��- W ( Zip: �`�8'`�3
E-maiL• � .� �
License Number: �-2-Co Z- l �
Remarks:
Signature: �►��'��__— Date: S/� Lc� �
Original signature required on each submitted copy.
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IN-GR4UND GRAVtTY DISPERSAL AREA SepllcTank(s)Manufacturer:
l,iJ i �e s e�—
Stepped Elevation Trenches with Quick4 Standard-W Chambers
SepUc Tank(s)Volume(s):
3-ffi Trench (down-sizing credit) IooU q�, gal �gal g��
_____�._}L 1 ',[ftluent Fflter M�nufaclurer:
I �lll'=-- - � �a � ol�
� SOIL COVER
min.12„
(ryplcaq E(fluent Fllter Mafel tf: �Z�
12" ----- --
min.Irench
TYPICAL -TRENCH deplh — - •
CROSS SECTION VIEW �'y��`a0 �: �
� _ _- _..._._._._........ .... ......._._-_ .4.. ' .
(NO SC�IG'� ' . •. : '• •' •' °. °� Provide minimum 3 fl ,
1---- 3�"-'---.--;-1 •a� separaiion bc�tween tr�nches.
(�YPlcal) 'n . .
n . °•' ' e a I
1-lighest�Trench ----------------- ----- Lowest Trench(as applicable)
System Llevations-� �1 Z�2S ft; �Z•ZS ft; fl; ft; ft
C�ulck4 Standard-W
w/End Cap OhservallonPlpn 1-YPICAL TRENCH
-- (typlcal) (Show lor,ation of inlet/outlet pipe connection on plan view.) (typlcal)
Inslall por manulacluror's F'LAN VIEW
� Inslrur.qrnis.
(No Scale)
i-, --- --- -- -- - �- - --- - - - �j� --_ ___ ._.. ._. .__ __ . _. .�f. -_ _ _ - - ,, - -- -- --,-- — - -� - ';
( � ; � � : � � - {! � � A= 3.Oil '
I_._. _:._- -- -- __ .— t', , � � �
, , ' — -'- �— -- —� (�Yplcel) �Q
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� �
B = �c� ��
I-------
--- f, �---------- — - --T� m ,
(typlcal) Quick4 Standard-�W Chamber W
INSTALL PER TRENGH: (rypicaq � ,.
(mfd by Inflllrator Syslems,Inc.) -�-) I
Inslall pursuant lo ma�ufacWrers instrucUons.
�� Quick4 Std-W @ 20 ft�EISAlchamber= 3�n ftZ "P i
+ �L Pairs of end caps @ 6 itZ EISA/pair= 6�ft2
= Proposed EISA per trench= s.3�� ft2 Required Infiltration Area= ��3 ft` Disiribution Method: '
3 Y�
x 2— trenches = Proposed Total EISA= ,� tt2 q��� � �
. 6� a
�.�.� ;
PAG E �0 F � .
{n-ground �ravity Managerr2nt Plan
1MPORTANT:
The owner of th:s ir:-ground graviTy system snal! be responsibfe fcr its perpetua! operation and maintenarce pursuant to
reGuireme^is o`SPS 382-384,Wisc. F�dmin. Code. Pursuar,t to SPS 383.52(2;,Wisc. Admin. Code; this system shail
be considered a Fuman �eait� nazard i*no�maintai^ed in accordance with this 2pproved management plan.
Fu,�hermore, aiI inspection 2nd mairtenance�ctivities shali be per�ormed by a registered POWTS Maintainer in
accordance wiih SPS 383.52 (3),Wisc.Admin. Code.
Maximum Dispersal Area Opera#inq Limits:
Desigr, Flow= �"�G gpd; 30D5�220 mgL"'; TSS 5'i 50 mgL''; FOG _<30 mgL''
' {nspection Checktist 4NSPECT EVERY 3 YEARS
o tyoe os use
o age of system
o nuisance factors (i.e. odors, user con�laints, etc.}
o mechanica! mal�uncfior (i.e., pumps,vaivss, switches,floats, etc.)
o material raiigue (i.e., ieaks, oreaks, corrosion: etc.)
o solids volume in anaerobic trea`u,-�ent tank;s) and any distrbuiion appurten2nce(s, (i.e., distribution/drop boxes)
o neglect c-improper use (i.e., exceedir,g design ca�acities, prohibited aciivities, etc.)
o extent of aonding ir distrib:�tion cell pr.or to dosing
c dosing irregularities-if applicabfe ;i.e.: pump re-cyciing,float switch settir;gs, etc.)
o electrical cornporents-if applicable(i.e., wiring, conneciions, switches, controls, timers, alarms, etc.)
c distribution I2tera(or!ateraf orifice plugging (me2sure Eatera! distal pressure—compare to design specification)
o surface discharge er efriuent or sewage back-up into structure served � .
Maintenance Checklist 3l�Aai��'Al9V EVERY 3 Y�ARS (o�when necessary)
o Septic and dose tank;s;sh2i1 be pumped by a cer�ified sept2ge servicing eperator licensed under s. 281.48 VVis.
Stats.when the volume of setids in the tank(s}exceeds one-th:rd ('il3)the liquid volume of the tank(s) or
as required by iccGf ordinance. Disposal of contents shall be pursu2n�to NR 113, Wisc.Admin. Code.
c Effluent filterfs)shall be ir�spected every 3 years and shali be cleaned when necessary to remove any
accumul2.ed solids accorcing to ranu�ac�urer's speci ications. A servicing period will aiways be greater thar, 12
mcnths.
System maintenance reports shalt be s�bmi:�ed te tne proper Eoca! government urtit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any comportent failure ar ma[function to:
Name of individua!or compary: n0 .6 {� bc�.rce.r � � �q Phone: ��S --���� �� 3 �
Local government ur.it: S�'c.�.,c�U{� C o �o vi i.�.o P"one: ��S—63 4 _�5Z8 P-,-,
Local governmen; ur.it address: l J d(� �'1�,ct.�� S"�' � i-{t (-�-�y i.�rc� Le„��p; �'z{4�s�{3
�
Any defective part of this system s�a(i be repaired, replaced, or removed pursuani to SPS 383.51 (1),Wisc.Admin.
Code. Repair or replacement�f i2iied or rn2�*unctioning componerts sh211 cemply with SPS 383,Wisc.Admin. Code.
No preduct for cnemicaf or physicai restor2tion of:he POWTS m2y be used un;ess approved by the department in
accordance with SPS 384, Wisc.Admin. Cede.
Continqencv P6an
!n the event tnat any�ailed treaimen;componen�of this POWTS c2nnot�e�epai�ed, it shaff be repiaced pursuani to
a plar submitted to tne approp�iate agency for review and approvai. A failed in-ground dispersal component may be
abandoned 2nd repl2ced by a code-corr.plyirg dispersai cemponert in a pre-dete�ired are2 or suitabfe soils.
Svstem Abandonment
if use of this POWTS is discortinued: it shaii be abandoned ir accerdance witn SPS 383.33,Wisc. Admin. Code.
`J/�— �` PRIVATE ONSITE WASTE TREATMENT county
��.\`.ilil�I!-���\\y�
;�;�SPs ��� SYSTEMS Sawyer
��ry ��j ( POWTS)
'"°'rs.`—'��r=i INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �a_p(.,'7
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village [�Town of: State Plan Transaction ID#:
�4-Q K� C..C.L ��SS (�I�—� --
Insp BM Elev: BM Description: Parcel Tax No:
I
�oo.o �v4�� �-�b Y '� �► o�, S . S��,.'�w� �bl ooa- `��ta - o�!-3�r y
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEU
Septic W�.��j'- �p Benchmark pp A�
Dosing
Aeration Bldg. Sewer q7.�� '
Holding St I Ht Inlet QY �(6 �
TANK SETBACK INFORMATION St I Ht Outlet �'7, �l �
TANK TO P/L WELL BLDG vEr,r ro ROAD Dt Inlet
AIR INTAKE
Septic ��� k�' ` ,�.y� NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. �,3,�� '
Holding Dist.Pipe
PUMP 1 SIPHON INFORMATION Infiltrative �
Surface ����
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS �N � L (o$ 6 � #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate 1'
P I L Bldg Well ❑ IGP � Chamber �
INFORMATION Waters � AG ❑ EZFIow Motlel Number:
CELL TO �—� �S- {�` ❑ Mound o Other Q
DISTRIBUTION SYSTEM X Pressure Systems Onry
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 ❑Yes ❑ N�
COMMENTS: (Include code discrepancies, persons present,etc.)
��,5��� ��a�laa
Plan revision required?�Yes � No �� � � � l, �c� � �� �
I/l.
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A��ITIONAL COMMENTS AN� SKETCH
SANITAAY PEAMIT NUMBEA: �-a.�C�6�
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