HomeMy WebLinkAbout032-539-26-2210-SAN-2022-108 .- Indushy Services Division ���Y �
- :;�.,t�� 4622 Madison Yards Way �Gl �� �
_�`\�_ � = MadisoqWI53705 SanitaryPe�mitNumber(tobcfillcd'mbyCo.'
�`, �f .� P.O.Box 7162 / �J
_
� Madison,WI 53707-7162 �D 3���� Q]
Sanitary Permit Application StateT'ansactionNumbe= o
In eccordance witA SPS 383.21(2),Wis.Adm.Code,submission of t6is(o'm to ihe appropfiare govemmental�mit �
is ra�ryired prior m obtaining a muitary pertniL Note:Application fomis for smm�owned POW7'S are submitted m Project Adchcss(if diffemit than mailing addr .
t6e Dcpe[tment of Sefcty md Nofesrional Services.Pelronal infotmation you provide may 6e used for accondary
puryoses i¢acco�dence with the Privacy Law,s.15.04(lxm),Stats. ���o
L Applicadon Information-Plesse Print All loformatioo •���
Property Owner's Name Pe�cel#
['i..J�d- � �t�Cl�P ri ��`��"n �� 5.3c a6 c�C2 jC7
Property Owner's Mailing Address �� Property LocationQRT,
sb 7—W SI.v�LYIiA r...�r... _
City,Staa Zip Code Phone Numbcr
�.�-�e�- (.c�-� S`lgi(� r�� ,Nw ,,��,a�
II.Type of BuOding(check all that appty) � Lot# T 3 N R 5 E o w
�l or 2 Femily Dwelling-Number of Bedrooms Subdivision Name
Block#
�'ublic/Commerciel-Describe Use ^
❑Ciry of
Stete Owned-Describe Use CSM Number illege of
— �ro�or (�J in.�,e(
III.Type of POWTS Permik(Chcck either"New^or"ReplacemeuY'and other applicable on tlne A.Check one boz on tine B.Complete line C i
a Ilcrbie.
A' �IVew Sys[em ��zcament System �Dther Modification ro Existing System(explain) Additional Preueatrnent Unit(e>.plein)
?�•nK R t�c.err.e�rE
B' ❑fiolding Taalc �In-Cmund �t-Gfade ❑Momd Individual Site Desi� OtAer Type(explain)
venuonal)
C. �Rrnewal Before �Revision itange of Plumber ❑I'tansfer to New Owner �st Previous Peimi[Number md Date Issued
Expira[ion �-v��p� �0'30"�70
IV.DispenaVfreatmeot Ares and Tank Informatlon:
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Mea Required(s� Dispersal Area i'roposed(s� Sysiem Elevetion c,'x;y{;n�
<lsu .s �3� �,5�; qy.
Cepeciryin Total #of Mmufactumr
Tank Informetion Gal�ons Gellons Units a� �$ .�
New TenYs F istivg Tanks �� �' N $�'� w
aU v,� �U a.
SepticorHoldingTuik 1! ��([� � Sk4U S.e RSZC
/�
�,�8�.��. o
V.Responslbillty Statlment-1,the undenigned,suume raponsibWty tor imWlatlou o(tLe POWTS ahowa on ihe attached plaus.
Plumber's Name(Prinl) Plumber's ature MP/MPRS Num6er Business Phone Number
Cr�,: • %•�,or.Qsan � � � ��2n�3tU 'J(S�66-oZ�Ya2
Phnnbci s Addeess(Street,Ciry,Smte,Zip Codc)
SoB�- !� 7�0 � GP � e� s S�I�Y�
VI.C unty/Department Uu Only
�A � ❑Di mved Scrmit Fce'Q Date[ssued Issuing Ageot Si�enue
�PP A4 y1}'
❑Owner Criven Reazon Por Drnial ��• �I��I�i r �2�"_`��r����
Conditions of ApprovaUReasons for Disapploval
D���i� ,«�7i�rl,
� �J��_--�_ I
O�IGINAL ��-ST a ► - �.�� ��� , 3 zo�� � _�
s.nw�vc,z c .� :
NING AGMINIS1�Hv;fiJtJ
Attaeh m comple4 pl�m for the syrtem aod sobmN[a tle Conty osly ou p�per eot la fb�e 81/1 x 111neho�u aite
S8D-6398(R.0321) NO REFUNDS AFTER
198UE OF PERMR
PAGE 1 OF 4
In-Ground Gravity Plan
Index & Cover Sheet
Component Manual Design References:
Version 2.1 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 Cross-Section
Pg 4 of 4 Management Plan
Attachments: Enctosures:
POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description
Owner Name(s): �aU;cX �- ���'��1C'.��� l`�rtnd! �e.n1 Phone: - -
OwnerAddress: s��7-l.c) S�nc��n, F �()��{�� Zip: �>`{4;`1!v
Project Address: S�i i�l �
Govt. Lot: l�w 1/4 of l`(1� 1/4, Section�, T�N-R S E❑or W �
Township: �i(� �(���( County: �u4,1��('
Project Parcel ID#: O�� S.3 / 02 Cn o1,� ��
Designer Information
Designer Name: C- (��� � Z� �} Phone: �1S -�b� - ��5��
DesignerAddress: (�S � ��0 5>� �e��e-r Zip: .S��Y�
E-Rlal�: (�C����(�"��.������_ �/UC'.�� ihi,space reserved for approval stamp.
LicenseNumber: �`��U��(7
Remarks:
� �Signature: �" � Date: - � v2
Original ' n ure required on ch submitted copy.
Reset Page
cnECK eox as aa�E. cHECK eox as nPaicne�.
� SOIL EVALUATION �1e '"-40' �SYSTEM PAGE2OF
SITE MAP � � � � LOT PLAN
PROJECT NAME: �o, DeSiGN F�ow� `'+�SU cPo
l'S r l!W h C�m Attach design flow calculations for commercial plans.
PRodECT ADDRE55: S(a87—4� ✓untQ�i nS �� Pipe Material l ASTM Stan{dard(Tables 384.303 8 384.30-5)
���.�o% N Sanita7Sewer �! / ��
BM Symbol: � BM Elevation: �
Fwce Main: /
BM��nw�: %c�P a � 4��11
Intlicate north bi IMPORTANT:
Slope Gratlient(%) � yyg�yy��ffappGcade): 0 a.aw��q an airwv Show ground elevation contours at suifable intervals.
Of TCSt¢tl F4�: on the approprite line.
SN
s�sz-w
�
� �
�
II
I o � �
I� I `
I � ^
� I � �
r � ��.,� az
�,� I N" PJ4 t'
� _ I J + ��t�:1 F,e r � �
� I,uw9°•IInnST �
�� �„ p�G Tu t'"��'� �
E� I {
��� ^ ' i
����� � � � �
4 � �
�T-,�"e�\ � j
61" I �
���
\e I \
�
�
� Reset Pag�e 'j
6AFFLE
54.00
SB.00
i•'-- ••� 64,00
/ � WARNING DEATH MAV OCCUR IF TANK IS ENTERED
� WITHOI/T PROPER EQUIPMENT _+'
1 \ `
1` � � V
124.50
`�. i � � �
`�'_'� i1B.50 J
TOP VIEW OF MANHOLE COVER �i I
�
�
FILTER �
3.00 23.00� 12.00 �23.00 �
<.o�� �-7
{--2�.��—I I—2�.��--I
24.00 24.00
5-°`°—� �J- TOP VIEW OF TANK (TAPERED)
(—ts.00—! i,o-
�-z.00
INL� � 11.00 �-- � OUT� � 56,0 —O seawmoa ;
________"""________ _ `\ �
41NCHPRESS 2'00 'g� v pRE S �� i
SEA�GASKET
INSTALLED SEAL i i
WHENPOURED GASKET
BAFFLE � �
36.50 FILTEft � �
I I
1 I
I �
I �
I 1
1 I
I �
� I
L _J
3.SOr SECTION VIEW OF TANK AND COVER �3.0o OUTLET END VIEW OF TANK
ModelNumber. 1000 SKAW PRE-CAST Phone: (715) 967-2277
Approved for. SEPTIC, SIPHON, HOLDING, OR PUMP Toll Free: 1-800-924-8625
Weight Inlet Dim. Outlet Dim. Liq. Depth Gal. /In. Max. Cap. 26255 105th Street, New Auburn
Wisconsin 54757 Fax: (715) 967-2707
- 83001bs. 42" 40" 36.50" 28.32 1034 gal. www.skawprecast.com
PAGE40F4
In-ground Gravity Management Plan
IMPORTANT:
The owner of this in-ground gravity system shali 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 pertormed by a registered POWTS Malntainer in
accordance with SPS 383.52 (3), Wisc. Admin. Code.
Maximum Discersal Area Oaeratins� Limits:
Design Flow = ��J� gpd; BODS <_ 220 mgL"'; TSS <_ 150 mgL-'; FOG <_30 mgL"'
Insaection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors(i.e. odors, user complaints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.)
o material fatigue (i.e., leaks, breaks, corrosion, etc.)
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 appiicabie(i.e., pump re-cycling, float switch settings, etc.)
o electrical components- if applicabie(i.e., wiring, connections, switches, controls, timers, alarms, eic.)
o distribution lateral or laterai orifice plugging (measure lateral distal pressure—compare to design specification)
o surface discharge of effluent or sewage back-up into structure served
Maintenance Checkiist MAINTAIN EVERY 3 YEARS (or when necessary)
o Septic and dose tank(s1 shail be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
Stats. when the volume of sollds in the tank(s)exceeds one�third(1!3)the Ilquid 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 filter(s1 shall be inspected every 3 years and shali be cleaned when necessary to remove any
accumulated solids according to manufacturer's specifications. A serviang period will always be greater than 12
months.
System malntenance reports shall be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malTunctfon to:
Name of individual or company: �Of1 �vl1�(1 � �� �C Z�- Phone: 7�5 ��v- �-���c7
Local government unit: S�W�e/� C�cn`�-f zc�h�r'��" _Phone: ?�S' 63y' gv2��
Local government unit address: j�'�'�� �u'n 5�• su�'�� �( �k�Gr,�v:;� ZIP: ���l£s���3
Any defective part of this system shali be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc: Admin.
Code. Repair or replacement of failed or malfunctioning components shail 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.
Svstem Abandonment
If use of this POWTS is disconti�ued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
!Reset Page j
`��'��-�'-`"`''v��r PRIVATE ONSITE WASTE TREATMENT �ounty
����. �SP . ��/� SYSTEMS Sawyer
\ S ( POWTS)
��k��-yCQ'�.
Ess,"-�,='� INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �� ,��bg
Personal infbnnation 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#:
�a���` ���9�-�l� < <,.�;�-�r ---
,
Insp BM Elev: BM Description: Parcel Tax No:
�,OC�.O� C� 'o� �'-�-� Z> —�` ���O—�.2 l C
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic S�,C/}W f O�o Benchmark �Oo,o�
Dosing
Aeration Bldg. Sewer �► �6, r
Holtling St/Ht Inlet 9�,.3 �
TANK SETBACK INFORMATION St I Ht Outlet QSQ.S''
TANK TO PIL WELL BLDG VENT TO ROAD Dt Inlet
AIR INTAKE
Septic .}(o` ��5� ,.}-(o ,�p� NA DtBottom
Dosing NA Installation
Contour
Aeration NA Header/Man.
Holding Dist. Pipe
PUMP/51PHON INFORMATION Infiltrative
Surface
Ma�ufacturer 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 #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav Conv Aggregate
P I L Bidg Well o� IGP ❑ Chamber Model Number:
INFORMATION Waters ❑ EZFIow
❑ AG
CELL TO ❑ Mound o Other
_-- -- - — —
DISTRIBUTION SYSTEM X Pressure Systems Only
— — --—
Header I Manifoltl 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 I Topsoil ❑Yes ❑ No ❑Yes ❑ No�
COMMENTS: (Include code discrepancies, persons present,etc.)
�.a=�,s��(� ���-Y���
� S,�'� c�e.���e�."�or'y
/
Plan revision required?�Yes ❑ No p, �3 �3 � � �� �� � I r
C�2�'"---- -- e
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AOOITIONAL COMMENTS ANO SKETCH
SANITAAY PEAMIT NUMBEA: �� '' I O�
�°�n . . .
���
b _
:
___ : __�__ /
. . . . .. ✓ ...�, . . , .. � ._.
. ,. . . . . . . . . � . . . . . _ ,
��
: , . . ' �. ,. . . . � '
: _ .: �:.........._ _,, . .. '. . . . - . ' ' � � ._ _ _ ' ' ' ___ . _ ^ .
i '
. ' _. . �. �. :_ �.. � �. :_ :.
! ; _ . _ '. ; � . ; ; � .
; .._ . . .. . . ��; ♦ _;_ _i_ � _�.. . _ I
... . ......._.. ...... ._ ... '.__.....
. . ..___. _... .. .._.... ..�...._.. .. ..
' , I��' � t
��`�r :
. _ .__ �
�
� ex�=
_ . �� �
v� ;
s�o�
l� � �
� �
� I� :
�
�
�^ �
( � �
I 5� 3
� �
�.0� �
��
5�
������� � .
� �a
S -