HomeMy WebLinkAbout032-338-30-5508-SAN-2022-129 _�Y-"`-""?; Industry Services Division County �
�� �` 4822 Madison Yards Way S � w�r �
��;i ���� � '-' Madison,WI 53705 Sanitary Permit �umber(to be filled in by C �
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�_ _ P.O.Box 7162
� �-=�'�� Madison,WI 53707 7162 O
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Sanitary Permit Application State Transaction Number ,,
�
ln accordance with SPS 383.21(2),Wis.Adm.Code,submission ofthis form to the appropriate governmental unit �
is reyuired prior to obtaining a sanitary pertnit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing adc �
thc Department of Safety and Professional Services.Personal infortnation you provide may be used for secondary
purposes in accordance wilh the Privacy Law,s. 15.04(1 xm),Stats.
l.Application Information-Please Print All Information � 9��6 F•1 w�s"t L-i�
F'roperty Owner's Name Parcel#
J d.rr�� �'�u vr✓r�c. 11 3 �-��3 Sd' SC�
Property Owner's Mailing Address Prope�Location
g �� N �Gy�f' L.�s cbYt.Lot ,�
City,State 7.ip Code Phone Number
� (� �Section�C
l�l.� . k.�-r t�.� .� S y Cc'�i L
Il.Type of Building(check all that apply) Lot# � 3� N R 3 E r W
C�f r 2 Family Dwelling-Number ofBedrooms 3'F Subdivision Name
Block#
❑Yublic/Commercial-Describe Use
❑City of
❑State Owned-Describe Use CSM Number ❑Village of
�ew 3ys+�e.n n
� � C3�own of ��-� � �-`�.r
5��«! �,^ 3 ��,�
lll.Type of POWTS Permit:(Check either"New"or"ReplacemenY'and other applicable on line A. Check one box on line B.Complete line C i
a licable.)
�' ❑ New S stem R lacement S stem ( p )
y � ep y ❑ Other Modification to Existing System(explain) ❑ Additional Pretreatmcnt Unit ex lain
B' ❑ Holding Tank �ln-Ground ❑ At-Grade gn ype( p )
❑ Mound ❑ [ndividual Site Desi ❑ Other T ex lain
(conventiooal)
�=• ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner
.ist Previous Permit Number and Date Issued
Expiration
IV.DispersaUTreatment Area and Tank Information:
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Arca Required(s� Dispersal Area Proposed(s� System Ele�ation �
�s-� s` tSa a ► �syY 9,?_w + �f 3_?>
Capacity in Tota) #of Manufacturer
Gallons Gallons Units � o '� �
Tank►nformation � � v ;: N
New Tanks Existing Tanks L a � � � � � �
G�1i ....��a{C o C��••cre�C a U �n' v, v� r�.. c7 a.
Septic Holding Tank v .�� �� � �� �f.
�� 1
Dosing Chamba X O@� � i 1 �( �
V.Responsibility Statement- 1,t6e uodersigned,assume respo �bility fo 'nstslla6on of the POWTS shown on the attac6ed plans.
Plumbers Name(Print) Plumbcrs Sign re P 1PRS Number I3usiness Phone Number
5�.,,w► ,.�u�.w5r,c.i ��6 BaG
Plumber's Address(Sheet,City,State,Zip Code)
�0 �t.>�V��k/ � �cr..�� I � J :� L Ll.4�C, l��Q. �� �� � J V'-� .�+ � ��S� �
VL C u ty/Department Ose Only
�Ap d ❑Disapproved Permit Fee Date Issued Issuing Agent Signature
❑OwnerGiven Reason for Denial � Ivv� �I�' I �'} �/vl��'�1��f��
Conditions of Approval/Reasons for Disapproval � �, ���
. , � �ry�'� f. �` t .�
l �
F . .�l�f:'.'__'_`"__'_..___._. �1
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�W� SI a 0 � �3 t�t 6 af� ��� �' ,�. .i: �n-'Y4hTl��i�
Attach to complete plan for the system and submit to the Couoty only on psper not less than R t/2 x 11 inches in size
NO REFUNDS AFTER
sB�-639g�R.o3i2t� ISSUE OF PERMIT
PAGE 1 OF 5
� In-Ground Dosed-Gravity Plan
Index & Cover Sheet
Component Manual Design References:
Version�.Q,SBD-10705-P(N.01/01,R.10/12),,.
Pg 1 of 5 ��1 Index 8�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 Plan
Attachments: Enclosures:
- --- __ _ ---- _ - ----
_
Pump Curve POWTS Application for Review
---- -------------- ----
Soii Evaluation Report&Site Map .
_---_ � _ _ _._._ _----
_ _ — _ __— � ___ ----- -
Project Name/Description
Owner Name(s): .�e�r r o�c� N o, t�r�a,a I< _ Phone:
Owner Address: a q$g N v.rc��' L ►.�w:�.-1�., W3 Zip:
ProjectAddress: `s' � � � a Qi �q N Wcsf- L r�
Govt.Lot: s 1/4 of �_ 1l4,Section 3 a ,T 3Q N-R 3 E❑or W❑?4
Township: w s�.kr County: g�,�r
Project Parcel ID#: 3�3'3�6 o S-�0 4
Designer Information
Designer Name: 5�.." Jo�.._N sa... Phone: - -
p h�I 1lps ^
Designer Address: Aa .�a�W6�.,i So w 1�is N Lc•It� �p:5`'�Ss'S
E-mail: ao�isaollo.t�c+c �.�_ r+�f -�'r
License Number: ��L$oo
Remarks:
Signature: ✓ N Date: 6- 1�•�
Onginal signa�ure reQui�ed on each submitted Copy.
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�'��pped �levatian i"ren�he� wi�h C��ick� �t�r�d�rd-W ���nnbers
3-ft Tren�h (�o�vn-sizirog cr�dif)
1 �-.-�— �
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—min 12'
�'Yp'�''� TYPICAL TRENCH
SOILCUVEf� CRt7SS SECTION VI�W
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12" �/��- —
min irench •�' ��p 5'Ca�@�
doplh
(�YP1crA) "
h ...,........,. ,..._. f[�...�........._..--P .' � d �e
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(�YPIG�iI) ° .� a . . �� �
• " Provide minimum 3 it
Highest Trenoh - - - •--------�- Lowest Tronch (as applicablo) separat(on between trenchas.
System Elevations= "I�.-"{ ft� `t � . '-1 ft� q 3..� f�; q 3• � ft; ff.
Quick4 St�ndard-W Obaorvall�n�Ip�
W��n����p (Show locatfon of Inlet/outlet pipe connectfon on plan vlew.) �ryp�'�'�> TYF'I�AL TRENCI-I
(lyplCal} Inslnll per manWac.turere
/Inslruauons. P(AN V�EW
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(typlcal) �nuicl<A�Standard-W Chamber I'TI
(�YPiCaI) W
lNSTALL PER TRENCH: (mtd�y�n�i�tratorsystems,i��,) a
In�lnll puruuant to mt+nufnclurer'e InstrucUuns.
��1 •,,,,Quick4 Std-W @ 20 it�EISA/chamber= � ft` �
Ui
+- � ,;,�„ Pairs of end aaps @ 6 ft`EISA/p�ir= � �tz
�Proposed EISA per trench= ��_. ft� Requireci inflltratlon Area= `�d_� �� Distribution Method:
x � trenches = Propnsed Total EISA= .,1��,ft' �G 3 �
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, PAGE40F5
� GRAVITY-DOSED
SEPTIC / PUMP TANK SPECIFICATIONS
(No Scale)
4"0 Vent Pipe
>70 ft fio�rt
Bueld'mg Eleclrical must o4mply«ith
12"Min.or 2,0 9 anove SPS 316 and NEC 360
Established Flaod Ele�ration W�����f Extend manhole riser as neczssa.ry.
t����� vunct�n Box
AEa{xined
Vunl Cap App:oved loc�cing MsnFwle
IMPORTANT: va:.th Waming labe!Attacned
Anchor tank(s)as necessary � ��yp����
-�—Cor,d�it
pUrsuant to SPS 383.43(8)(g} a^f�fin,or 2.o R above
f—EstaDlished Fiaod Eleva6on
(�YP��J
�Airtight Sea1 � _�
Finished Grade
" ��� Qu-ck DiscarneG �
�. -x 18"Mi�.
CAPACITIES @�gai�n � • �'Y�"�'3
��y 4 .' • � ---- ;� � �
Dep h in} Volume(gal} '� 1
;
� n * } � �1
A 1 ��d_ �b �j<�_7� I � `Jdeea �Approved Jo+nts vAth
� Ho'e Appm�:ed Rpe 3 R onto
B `Z.� �,�� �0.'i� ,� I So�id Ground
J � ((yoicai)
LC� /'
� �s�.s� �I_ ���a,��., �
� 1� �J�:9..0 �o��{) •�2� 9 ��_.Gn
f ��� PUMP-OFF
� P�'"° (a ELEVATION = `�C� ft
'kPump Tank Liquid Level =�`� �in � �—�`` ` o,.s.—_
Force Main Diameter= �� ^ � ��ue1e INSIDE BOTTOM
� � � a'°�k ELEVATION = $'7 ft
ti �
Force Main Length = �t"9 f� 3"Aporo�re�Eie�idi�g Eaaletial Heneath Tank
:, � 2� . i(� 9yll�� f �kL�,
Farce Main Void Valume = 6�S°Z ga! " _ 1 � $ ���s ' ``�
o.lb� y�ll�.�.-� G� �
[C]Totat Dose Volume (T�V} _ � ,'S� gal/dose
���� �� r 3wZ 1,
�--{<0.2X design flovJ+force main void volume)
Vertical Lift= � • ft
PUMP TANK: SEPTIC TANK�S):
Volume = i p�Q' gal Total Volume = 1 S� � gal
Manufacturer: O w+���.c ���.,;,,,.�:�z pr��.�i-5 Manufacturer(s): a �-�� �vC�-�..��. p�e�,�
�.� . ..������l� ..�.
Pump Manufacturer: Za ���-�-
install approved effluent filter at the septic tank outlet
Pump Model: ��' `�� ;�8�,��,�p,,,�,�,,,,,e; +mmeciiately upstream of the�ump tank inlet.
Controls/Alarrn Manufacturer: S � � �,o w,(��_4 Filter Manufacturer. g3-r-��-- Pa l�1 ce,�G
�.�,� ..�..�...�.�..�. ����
Controls/Alarm Model: P S P� (�
��� n��nw��w���w���a��� Fitte�Model: �--C��LZ-a �a �6�' 1- L. � ��
Ftoat switches containinq mercury are�rohibited.
(�s `�
./
MANAGEMENT PLAN
This Private Onsite Wastewater Treatment System(POWTS)has been designed,and is to be installed
and maintained according to SPS 383,Wis.Admin.Code,the In�'iround Soil Absorption Component
Manual for Privaze Onsite Wastewater Treatment Systems(SBD-10705-P;N.Ol/Oi),
and the Sawyer County Private Sewage System Ordinance.
1. This POWTS has been designed to accommodate a ma�cimum daily flow of 450
gallons of domestic wastewater-per day.
1'he quality of influent discharged into the FOWTS treatment or dispeisal component shall be
equal to or less than all of the following:
•a montWy avernge of 30 mgfL fats,oils and grease.
•a monthly average of 220 mg/L BODS.
•a monthly average of 150 mgfL TSS.
Wastewater shall not be discharged to the POWTS in quentities or qualiries that exceed these
limits or that result in exceeding the enforcement standards and prevenffitive action limits
specified in ch.NR 140 Tables 1&2 at a point of standazds applicafion,except as pmvided in
SPS 383.03(4),Wis.Admin.Code.
2.T'he owner of tfiis POWTS is responsible for system opeiation and maintenance.The following
maintenance shall occur withm tluee(3)years of the date of installation and at least once every
three years thereafter.
A.The septic tank shall be pumped by a certified septage servicing operator,licensed
under s281.48,W is.Stats,unless inspection by licensed master plumber or other
person authorized to make such inspection,finds less than one-third(1/3)of the tank
volume occupied by sludge and scum.More fiequent pumping may be necessary to
prevent solids from exceeding one-third(1/3)of the volume of the tank.
Wastes shall be disposed of by the pumper in accordance with Ch.NR 113,Wis.Admin.Code.
The septic taok/dase chamber is within 150'and not more than IS below the servicin�pad
SPS 383.54(Ixe)states:"The management plan for a POW'I'S shall specifically
address the servicing mechenics of an aerobic or anaerobic trea�ent tank or a holding �
tank where either of the following conditions exist:
1.The bottom of the tank is located more than 15 fcet below the elevation where the servicing pad is located:
2.The bottom of the tank is located more than 150 feet horizontally&om where the servicing pad is located.
At each pumping the pumper must visually iaspect the condition of the tank,baffles,
riseis and manhole cover and verify that any required►ocks are present.
PaRe�of 6
3
B. The soil absorption component(s)shail be visually inspected by a licensed master
plumber,certified septage servicing operator or POWTS inspector.Inspection shall
check for evidence of discharge of sewage to the ground surface and for ponding of
effluent in the distribution cell.
C.The tank filtec(s)shall be inspected and cleaned to remove any accumulated solids
according to manufacturer's specifications. The filter cartridge shall not be removed
unless provisions are made to retain solids in the tank_Cleaning of the filter at more
frequent intervals may be necessary.
D-Any pump,alarm or related electrical connections shall be visually checked for defects
and tested to confirm thai they are opeiating properly.
E.Reports for all system maintenance shall be submitted to Sawyer County in
accordance with SPS 383.55, Wis.Admin.Code and the Sawyer County
Private Sewage System Ordinance.
3. Defects or malfunctions identified during maintenance described in item#2 above shall be
repaired in conformance with SPS 383, Wis.Admin.Code,and the Sawyer County
Private Sewage System Ordinance. The User's Manual, provided to the owner of the POWTS includes
the names and telephone numbers of tl�e properly licensed individuat(s)to contact for such
repairs.
4.Anytime a failure or matfunction occurs, it shal]be reported to the peison(s)identified in the
User's Manual for this POWTS.Repair or correction of such failure or malfunction shall comply
with SPS 383,Wis.Admin.Code,and the Sawyer County Private Sewage Ordinance.
5.No one should enter a septic or other h+eam�ent tank for any reason without bemg in fiill
compliance with OSHA standards for entering a confined space.T'he atmosphere within these
tanks may contain lethal gases,and rescue of a person from the interior of the tank may be
difficult or impossible.
6.No product for chemicat or physical restora6on or chemical or physica]procedures for POWTS
may be used unless provided by the Department of Commerce in accordance with SPS 384,
Wis.Admin. Code.
7.In tLe event that this POWTS or a component of this POWT'S fails and cannot be repaired,the
following contingency plan is proposed:
If system failure occius, a new certified soil evaluation will be completed to identify a new are�
for a replacement system.
8. If this POWTS is replaced,or its use discontinued, it shall be abandoned in accordance with
SPS 383.33,Wis.Admin.Code.
Form No.OPOWTS-13-004 Revised:7/0$/L004 PageS of 6
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I't�-�2� PL-62� FEAT4�RES � �E�E�BI'�
�
F�a��ar�s � F��r►��its:
,
� � � �, �� m Rafed for 10,QU0 G�D
.. .. i ;`�=;
, �,-.. _; � ;.�
� -"' � � � �- � PL-52� = 525 Linear Feet of 1118" F1ltratidn
� '�"'`��� ' `���� PL_625 = 62�5 Line�r Fe�e# of 1f32" Fllfratian
. ii��.�i ���I'
p�..525 p�..g25 aAccepts 4" and 6" SCHD. 40 pipe
The PL-5�25 625 Effluen� Fllter should oper�te ��ficien�ly � Buil� in Gas De�lector
�'or several years under narmai canditi�ns bef�ore �,qutomatic �hut-C�ff Ball when �ilter� ls Rernoved
requiring cleaning. �t is recomrr�ended that the fliter be
cleaned every �irne �he tank is pumped ar at ieast every �,q��rm Accessibility
three �+ears. 1� the ins�al led flit�r con�alns an optianal
alarrn, the owner will be� noti�led by an alarm v�uhen 4he �accepts PVC Exfiension Handle
filte�r needs servicing. Servicing shauld b� don� t�� a
certified-sepkic tank pumper ar ins4aller.
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WARNiNG: Mode{ 185i4185 shouid not
� t30
be subjeded to tess than 30 feet TDH.
38 ,25 NOTE: For Head Capacity on Modei
�Zo 112, Industriat cotumn-expiosion procaf
�6 t9, ' pump, see FM0219.
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U.S. GALLONS 10 20 30 a0 50 50 7Q 8� 90 tOp 410 120 130 140 150 16Q
UTERS gp t60 240 320 400 480 560 640 •, • ..
p FLQW PER MINUTE
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�Fss'°�•=' INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �.� -- ��9
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(l)(m)J
Permit Holder's Name: ❑City ❑ Village [�Town of: State Plan Transaction ID#:
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Insp BM Elev: BM Description: Parcel Tax No:
(eo.o ' co�.�. s� �►� s��, � c-�,► o �_ 338—30-
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic ph; - ��� op Benchmark )po.o�
Dosing -�„��,p
Aeration Bldg. Sewer ,��'�
Holding St/Ht Inlet �QS`
TANK SETBACK INFORMATION St I Ht Outlet Z7 S- `
TANK TO P/L WELL BLDG vENr To ROAD Dt Inlet
AIR INTAKE
t
Septic -F(o� �- �-aS' �-�� NA Dt Bottom �'�,�j
Dosing NA Installation
Contour
Aeration NA Header/Man. R�(,q�-�
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION infiltrative
Surface R 3,0 . 9 �
Manufacturer �,�laf� Demand Final Grade
Modei Number a$ GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L �a � Dia •� Dist. To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W L � 7 � #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate �� '�
INFORMATION P/L Bldg Well Waters o GP ys� Chamber Model Number:
❑ EZFIow
CELLTO � '�'� .�-� ��S'� ❑ Mound o Other QY�
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 ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
� ��57��1� ���a°�-a
Pian revision required?�Yes ❑ No �� �$ ��� � .. � � 6c� �1/ �
b
Use other side for atlditional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A��ITI�NAL COMMENTS AN� SKETCH
SANITAAY PEAMIT NIJMBEA: ��--1 ��__
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