HomeMy WebLinkAbout030-737-36-5606-SAN-2022-068 Indu>tr� �crcicc�[)i�i�ion C�nunic _ ��
� -1R�' Muditioii l'�.ir�i��N'�� �� i�1,W ��/' �
�$� - i hl idison. W I >370� Sanitar�'Permit Numh�r It��bc tilicd in b�'Co.l �
s P.O. L3o.7302 � 3� c � � . �
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Sanitary Permit Appl ication - �``'``�r"",s��``°"""'»�`�r ��--�- �
In ticcordance with SPS 38321(2j,Wis.Adm.Code.submission uf this tunn tu the apprupria�e guvemment�l unit �
is required prior ro obtainin,a sanrtar��permit.Notc:npplicatiun�i�rms ior�tatao�cned PO��I��S are si�hmitted to Proj�ct Addre,s(if dif�crent than mailing�ddre,s �
�ie Department of Safet��and Pr���cssiimal Scrvicrs. Pcrsonal inlonnation���u providc oia��bc uxcd tur secondary � �P��Q (,�� /�� �
ur oses in accordance�cith the I rieacy La��.,. I>.O�JI I)(m)_Stats. � - u (C
L Application Information-Please Print All Information
Prupertc O�cncr�s Numc ti -- (7�(���(�+(�— Parccl#
I�c�n U �c� � C,h e ry �' Ll./i � C� .� u��3�2�0 3 0-737-36 � ,��o�� -----
Propert��Ou�ner�s Mailing Address Properh�Locatiun
6 3 3 2 e�' � �e� I�o�- ���,��t �.,,�
Citc State Zip C��dc Phonc Numhcr
. �- _�w_�<,.__,u w_ ��. s�<<��,�, _ 36
I1.Type of Building(ch cl.all that aPpIY) I ot ir � ~ -- - --- �
es c� v► � fiyY76 7�5-�6 _ 32s�
3 -- �7 _N R _7 Llf�ur� ------
�'I or 2 Famih�Dwellina-Number ofF3edroum, Suhdi��isum Namc
�131uc1.� �
❑ Public/Cummercial-Describe Use �- —
I ❑C ih of-- ---- —_---
❑titate Owned -DeScrihe Use_ ('SM Number ❑Villageof
[��I�o���n�it�-- �����Y'�1g,L/- --- __
J
Ill.Type of POWTS Permit: (Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C if
a IicAble.)
`�� �Ne���Syslem ❑ Replacement S��slem � l)thcr!�ludi�icati�m to Ezistin��S�:titem(c�plainl �� Additional Pretreatment l!nit(r�plain)
�.
❑ Hulding�fank �-(iround ❑ At-(iradc U !�lound �� Individual Sitc Design ❑ Othcr�I���pc(cxplain)
(convenlional)
��• ❑ Rene���al 13efure ❑ Re��isi�m ' ❑ �I�ran�lcr t���'��c O�����i�I.ist Prcviuus Pcrmil Numbcr and Date Iti�uc�l
❑ Chan,e��f I lumhcr
1{xpiration � .�
TV.DispersaUTreatment Area and Tank Information:
Desi�n Flow(gpd) I)c�itn Suil npplication Rate(�pdi�� I)isper,al nrcu Rcquirod(sl� Disper,al nrcti I'ropuscd(s�l tivstcm I[levatiun
� d • 7 6 �J3 65Z 96. c�
Capacity in l�otal /t uf h1anufacturer
v
Gallons Gallom llnils L ,� ? �
�Cank hiformation � �
Ne�c Tanks h.sisting Tank, � _ � � � � `�
— J ✓: .n ✓: i_ .� G
Seplic or Holdine�I ank � /� ���� � (� � ��� _ �..( � —
— �� ur �
/� --- — � O --- _------ ---
Du,inc Chamher / / y� � � "` - - — ----
C:� �G r� b d li.�
V.Responsibility Statement- I,the undersigned,assume responsibilitv Ibr installalion of the P01�'"I'S sl►own oo the attached plans.
Nlumbcr�s Namc(Nrint) Plutnbcr�s Si�*ntdur� MP/MPRS Numbci-- Rusincss Phonc Numbcr ----
�
\ 2 2_7/ 7 / J15= �'!6�'l-7& 7$
J d e e�r _
Plumber's Ad ess(StreeL Citr.Statc.Zip C c)
\Il� I �31� /� � c� Lk• �c�• /U�w �u-l�urw ' j'N s—
Vl.County/Department Use Only _
� r ��c ❑ Disapproce�l Permit I�cc Dale Issued Isuiina/1��cnt tiianaturc
� �, � y� � s i k�22 � �:��.��,�,=-
❑O�cner Given Rcason for Dcnial `
Conditions of nppro��al/Reasons for Disappro�al
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c s�-�- �� - b� �.� :r_��J�__�r-'.=--,
� � s�� � . ��
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�; ���,� 0 2 Zo2i ; .
:�ttach to complete plans for the s��stem and submit to the(�ounh�unl��on p:iper not Iess th:�n S 1;2 x I I i��'��7i�tS�j � `
NO REFUNDS AFTER ZpN1N�ADMINtSTRL�TfOt�-
s►��-�39s�R.o2iz2> ISSUE OF PERMIT
;
PAGE 1 OF 5
In-Ground Dosed-Gravity Pian �
lndex & Cover Sheet
Componenf Manual Desrgn References:
Version 2.0, SBD-1 Q705-P (N.Q1/01, R. 10/12), ,.
Pg 1 of 5 I ndex & Cover Sheet
Pg 2 of 5 Plot Plan
Pg 3 of 5 Dispersal Area Cross-Section & Plan View
Pg 4 of 5 Pump Tank Specifications
Pg 5 of 5 Management P{an
Attachments: Enclosures:
Pump Curve POWTS Application for Review
Soif Evaluation Report & Site Map
Project Name / Description
Owner Name(s): (�or,al�I �` CtiP�.. I Vt/iI� Phone: /S - 66 3- 3 2�'9
Owner Address: !6 3 3 20 JC e rs1'�v► j�a� � lrtl es'�o T�(�; Zip: ��f Y 7G
ProjectAddress: O�pp1�e b e e R�I , �(/��e.rgar �wS�y� .
�
Govt. Lot: S 1�l_1/4 of ��✓1I4, Section 3G , T�N-R��E �or W�
Township: �l/ ���rG o r County: S0.w ��-
Project Parcel ID#:
Designer Information
Designer Name: 1 �e rv� S G o e h ��.r Phone: 7lS -g24 - 07 S"�
Designer Address: 1�/ � {S � L (<. �- Zip: �y 7�7
E—Il'181�: �12.W (J1 1�..�p tt d'.�. ��� S�-1 �r�� �l'3ti�;�:��.ti:e���r•se':•ti�t,�:i�:���;a�7pr�rH�ai t;���nv�,.
LicenseNumber: �22 ?/7/
Remarks:
Signature: Date: �/` 2 7 " 2 Z-
Ori 'nal s' ature required on each bmi d copy.
CHcCK BOX AS APPLICABLE. � CHcCK BD;(AS APPLIC.nBLE.
� Sa1L EVALUATIQN a s����:�o� `'�`� �� [�'S'YSTEIVI �AGE 2 OFS
S9TE �/lAP P�.O�' PLAN
PROJECT NAME: � 2 DESIGN FLOW, f"£S C� GPD
! �"ftgrlc) 12.5
���a�� � �' h�,�._T_�`��°3, � - ACach design�iow calcutations fcr commerciai pfans. I
_ `��L
PRo,IECT ADDR=ss ��%� {Q,f�S�-'e f'�C,�. Pipa Materiai!AST�1 Stz7dard(Tabies 3&�.30-3&384.30-5)
N Sanitary Sewer._ ��' i�C.�.. �-1 C; ��!�.- {
HM Symhol: � BM Elevatbn: i n 0- � FT �r p ,,
�- a /� Force Mdin: 2 (
4 BfJ�Description, f_�C)l? 8 ,� f"�'�. �P�"' ��r �.)d. � �
T'
t Irnficate nonti by i ti1PG�RTAI�ET:
Slope Gradient(%`, � Well Symbol(if appiicable�: � a,�in9 a�a.,o�+� Show ground�fava±ion co�:ours at suitabie in!ervais.
ot Tested Area; on the approprhe I�e. �
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-�------
—�r`X(715�868-7878 --
IN-GROUND DOSED-GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down-sizing credit}
�
"''n�12" TYPICAL TRENCH
SOIL COVER (ryF�ca1)
CR�SS SECTION VIEW
,2��
min,trench (No Scale) -
depth
(typicai) o '
, •e"
�d <.
�—�—_ 34" • . .
�ryp[0a�� , , Provide minimum 3 ft
a d.
" �eparation between trenches.
System Elevation = �6•�fi
(typical)
Quick4 5tandard-W
w/End Cap � Obsen�atlon Plpe
(typicaq {Show location of inlet, outlet pipe connection on plan view.) (tVpicaq TyPICAL TRENCH
instalf per manufacture�s
InsrrucGons. P�N U�EW
(No Scale)
� — - - - �� - - - - - - - �� - - - ��� _ � `� �
��- �.e�;,-�; � � � F`'z 's s �K� «�( A= 3.0 ft
1 ���:- �. �: � .e r�'* ., r..,� �,�.oi �,` a (Y��PICaIj
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- - - ��- - - _ _ _ _ _ y� _ _ �
B = 6 S ft ---� D
�
(typical) Quick4 Standard-W Chamber �Tl
INSTALL PER TRENCH: �ryp���� W
(mfd by InSltrator Systems,Inc.) O
f O Quick4 Stci-W @ 20 ft�EISA/chamber= �Z D {fz lnstall pursuant to manufacturer's ins:ructions. ,�
CJl
+ �_ Pairs of end caps @ 6 ft`EISAlpair= � ftZ
=Proposed EISA per trench= 3 Z 6 ftZ Req�ired Infiltration Area= 6 �t f�2 Distribution Method:
x 2 trenches = Proposed Total ElSA= roS 2- ftZ �05 2 N �.
.r. g,�K �.�l
,, �;
PAGE 4 QF 5 _
GRAViTY-DOSED
SEPTlC / PUMP TANK SPECIFICATIONS
(No Scale)
4"0 Vent Pipe
>10 fl from
6uilding Elec!rical must comply with
12"Min.or 2A ft above SPS 316 arni NEC 300
Established Flood Elevation Wealherprx�of ��end manhole riser as necessary.
(typcal) Junclion Box
Approved App.�ved Locking h9anhole
IMPOR7ANT: Ve,nt Cap with Waminy Label Altached
(�YPical)
Anchor tank(s)as necessary �---Conduit
pursuant to SPS 383.43(8)(g) 4"Min.or 2.0 fi above
Estabiished Flood Elevalion
(�YPical)
�A rtiyhl Seal
Finished Gradc� _ �
_" Quick�isccnnecl
/
CAPAC{TIES �J�• 2 3 a� ts^rvtin.
@ galrn ': & . < (lypicafl
�� a �
Depth(in) Volume(gal)
A ��+ � �/' �� *� Weop •�Approved Joinis wilh
Holc Approved Pipe 3 fl onla
B 2•� 3 D r L'�j A Solid Ground
I (�YPica�)
[cl 3. 6 5 S � e
� 12 18 Z.7 6 B ' 0 Alarm
—On
� (c] PUMP-OFF
*Pump Tank Liquid Level = �j z in � Pum� —Off < ELEVATiON = � � ft
�� ��
° INSIDE BOTTQM
Force Main Diameter=�`in `�g��kg
. . ELEVATION = �S � ft
. . ��.
Force Main Length = 2 O O {{ 3".Approved Bedding AAaterial Beneath Tank
���
Force Main Vad Volume = �2 gal
�...
[C] Total Dase Volume TDV = �j� gal/dose
(<02X design flow+force main void volume)
Vertical Lift= � z. ft
PUMP TANK: SEPTIC TANK(S):
Volume = �j ��� gal Total Volume = /, �^j G�L/ gal
Manufacturer: I-I U�fe w � r Manufacturer(s): I I tA 7 1 �-� �
Pump Manufacturer: z o 2 (j � r
,� l Instal) approved effluent filter at the septic tank outlet
Pump Model: l V � S � � immediatel}Lupstream of the purnp tank inlet.
Controls/Alarm Manufacturer: J (� (J� �.a o�er Filter Manufacturer: �--;re"� r `'�^ 2-
Controls/Alarm Model: � � !� � u- 4�i e r r� �� � �' ; � z e
Fi6ter Model: O �iS
Float switches contafnlny mercury are prohibited.
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PAGE ��OF �:
In-ground Dosed-Gravity Management Plan
in�poRrAnrr:
The owner of this in-ground dosed-gravity system shall be responsible for its perpetual operation and maintenance
pursuant to requirements of SP5 382-384,Wisc.Admin. Code. Pursuar�t 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= �'/5 � gpd; BODS<_ 220 mgL"'; TSS 5150 mgL�'; FOG 5 30 mgL�'
inspection Checkfist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors (i.e. odors, user complaints, eic.)
o mechanical malfunction (i.e., pumps,valves, switches,floats, etc.)
o material fetigue(i.e., leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s} (i.e.,cfistribution/drop boxes}
o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.)
o extent of ponding in distribution cell priorto dosing
o dosing irregularities-if applicable(i.e., pump re-cycling,float switch settings, etc.)
o electrica!components-if applicable(i.e.,wiring, connections, switches, controls, timers, alarms, efc.)
o distribution lateral or lateral orifice plugging (measure iateral distal pressure-compare to design specification)
o surtace discharge of effluent or sewage back-up into structure served
Maintenance Checkiist MAINTAiN EVERY 3 YI�ARS (�r when necessary)
o Septic and dose tank(s1 shall be pumped by a certified septage seivicing operator licensed under s. 281.48 Wis.
Stats. when the volume of solids in #he tank(s)exceeds one-third (1/3)the liquid volume of the tank{s) or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113,Wisc. Admin. Code.
o Effluent filterls)shall be inspected every 3 years and shall be cieaned when necessary to remove any
accumulated solids according to manufacturer's specifications. A servicing �ieriod will always be greater than 12
months.
Sysfem maintenance reports shal!be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc.Admin. Code. Report any componer,t tailure or malfunction to:
Name of individual or company: S C�h aeh p��'G J 0 i� �Q S�T�Phone: ?/5= f6� $� ' � 'c�S 7�'S
local governme�t unit: S{X W y.e r �Q �t� h; r A Phone� �/ S� ' ��LI ' ���� �
Local government unit address: ���j1Q��0.!h J�. �A� �r.t ��' z�P: 5 N �L13
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 POWT5 may be used unless approved by the department in
accordance with SPS 38Q,Wisc.Admin. Code.
Continqencv Plan
In the event that any faifed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to
a pfan submitted to the appropriate agency for review an�approval. A failed in-ground dispersaf component may be
abandoned and replaced by a code-camplying dispersal component in a pre-determined area of suitable soils.
Svstem Abandonment
If use of this POWTS is discontinued, it shali be abandoned in accordance with SPS 383.33,Wisc.Admin. Code.
I
I
�-"'�`�� PRIVATE ONSITE WASTE TREATMENT county
���/F� , ` �f� SYSTEMS s
;_ ? °Sp \��i awyer
�\f���j i ( POWTS)
��'='°V''=� INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �� _� 6�
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(I)(m)]
Permit Holder's Name: ❑City ❑ Village � Town of: State Plan Transaction ID#:
�a rl �—C�^at' l w',� � �^-� �-�C'�ia� �-�
Insp BM Elev: BM Description: Parcel Tax No:
�ata.a� � `' c 5�. � c f� b 3 0 -`�7��- ��—Sb o!o
TANK INFO MATI N ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic — 1�p2) Benchmark �Qp,p`
r
Dosing � ��p-p a0 e QT ' � `�3,
Aeration Bldg. Sewer � q�
�
Holding St 1 Ht Inlet g,S'
TANK SETBACK INFORMATION St/Ht Outlet g ,( '
TANK TO P/L WELL BLDG vENr ro ROAD Dt Inlet
AIR INTAKE
Septic �,tS� N �-(o� ¢.�o ' NA Dt Bottom $`�•��
Dosing �� � �� •. NA Installation
Contour
Aeration NA Header/Man. q�,��'�
Holtling Dist.Pipe
PUMP/SIPHON INFORMATION Infiltrative �
Surface 9S.`lS
Manufacturer (�- Demand Final Grade � ,'$ `
Model Number �� GPM �I�f�^ �'�, R7,(� �
TDH�'3 Lift Friction Loss Sys Head TDH Ft
Forcemain L 3.�' Dia 2 '` Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W 3� L (�j�{ (o c( #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav 6� Conv ❑ Aggregate ��� �
INFORMATION P I L Bldg Well Waters o GP t� Chamber Model Number:
❑ EZFIow
� i ❑ Mound o Other Q Y�
CELL TO �1',LS 't` O N _ __— --__
DISTRIBUTION SYSTEM X Pressure Systems Only
-- — - - —
Header I 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 ❑ No
COMMENTS: (Include code tliscrepancies, persons present,etc.)
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Plan revision required?❑Yes❑ No �„� � }. � , - J 6� � ��
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Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3I01)
AODITIONAL COMMENTS ANO SKETCH
SANITAAY PEAMIT NlJMBEA: �-_� --Fj6�
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