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HomeMy WebLinkAbout026-939-16-5402-SAN-2022-163 -- Industry Services Division r��Y � 48?2 Madison Yatds Way � � ,�.•�_ -... = Madison,W I 53705 Sani�uy Pamil Nim (b be fillod in by Cc � �Z : P.O.Box7302 �7 r j�i Madiso4 WI53707 �J J � � � Sanitary Pernut Applicarion SnaTnnsartionNumber � tn eccoidaa.ro witL SPS 38321(2�Wis Adm.Code,submisioo of Wis(arm m 1he appmpriate govc�mnenW wit -- is required prior ro abainmg a ranirary pertnit Note:Applicaoon forms for vatebmcd POWTS ue submiaed tn Rojact Addn.ss(if diff t thm mailing add 6' the Department of Safcry and Pmfessanal Services.Personal infortnation you pmvide may be used for secondary W pmposes in accoNance with Ihe Pnvacy law.s.I5.00(IXm/,Stats. ��'6tj� o��l a� Rd L Applicstioe lutormadon-Please Print All leformatiou Pmperry Owner's Name Pazcel R O�.1�-���j r�" �l,i/� ��t 0:� l, a ul�n� e 1'ropnty Owner's Mailiog Add�ess �r I.��� o a�-9 3 q-I6-SY v3 G>3� r�N o%l 27 D� �on.��� City,Smte 7ip Code Phone Numbcr 5i-o�� �.�� � sy.�7� _�—�,��� Q.Type uf Builm9g(t4etk all that aPPly) Lot M n,{. D J��/' T N R E or� ��7711 r' 9 s�na��swo N� �7JIor2FamityDwelling-NmnberofBed'oo��a� ^ — !-' 6lock# �'� �ublic/Comme�cial-D�cribe Use ityof we Ownecl-Descnbe Use CSM Nwnber illage of — �o�of�-1,� L�ke_ ID.7�pe ot POW7'S PermiC(Checic either�New^or"ReplacaoeoP'and other appl' ble oe 6ne A.Chedc ooe boz os liee B.ComplMe lioe C i a licable. �1,� �7�' A. �lew System � �ceplacemenl Sys�cm �p�Modi6cauw�ro Exisbug yshin( din) dditia�al Retreannrn[Uni[(erzplain) LJ 7�� D B. �olding Tank 1�In1'im�md ❑4t�'i�ade Mamd I�ividual Site Desi� Ot6er'Iype(explam) �F�( nvrntionel) ist Re imaPa�ittai�6Q:ad�bimed C. �Renewal8ef ❑Revision ofPlum6er ❑I'nas(erwNew Pa i �P�oo �-.25�, )��b 7�'d rv.uispenavfreatmmt nrea sna'rank[nrorm.riou: a - 0 9 o���r�ow(gpal oa��soa a���rs��{�:q o���a,ea u���red�s� rs.nrea r�o �a s� synem �e� �/50 D�? 3 Exisfi� ' � sF ��rs�rn 9l,7� Capacitym Total Nof Manufacmrer a�,3�' Tank Info'mation Gallaas Gallons Units �y., �� '� .� New Tmks Fivtm6 Tmks � /"d � e V J �' m m P.U rn� I+.U P. s�qK o,xa�rmt Lt�!t�'-e:✓ �osing Chueber O V.Ropoosibilily Sfatemeah 1,f!e ooderaig�ed,nsaae rapo■a'bliry far imu0�lfeo otthe POWTS sbw�a oa t6e arouLed plaos %umbcr's Name(Print) Plum6er's Signature MP/MPRS Nurtiber Busi�res Phw�e Nwnber ��— �?�-t ��5-Gy�-o�yy PI r s A (Strcet,City.Stafe,Zip C.ode) . 9 q� h�/l C�k� c�r.r 5yg> v�.ca� ineP.r�m�ux ooy .�A�.,..,"� ❑Disappmved Permit Fee Date I.ssued Iswing ABrnt sig�ature ' I .yr� ❑OwncrGivrnRcazonforDrnial El���pa �7�,�-S���i- T�-l�V-��t��"-^`� ( Conditions of AppmvaUReasons for Disappmval ��, ,rj�r-� '� G� .�C ��'i `, 0����1��� �ate?��S�a� �_� ,_ ; chk# �s(`° � JUL 2 2 Zfl22 �ST 2-�- �-` �{� ,_, __ _ . I � ��pt#i��kw Uv��k1'��i✓�-f1�� �a ���,�,o;a �m<e�e�p�W�..rer m�me�,.a,.u��m m�co.eh ewr�wra��w.m.e a�n:���a�,ro.� SBD-6398(R.07122) NO REFJNDS AFTER 19SUE OF PEfiMIT . . ��� PAGE 1 OF 4 in-Ground Gravity Plan Index 8� Cover Sheet Component Manua/Design References: In-Ground Soil Absorption for POVYTS Version 2.1 (May 2022-2027) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 T'�,n,l� .SP�c,; �ic�:fiio�t�---•• -- - -- Pg 4 of 4 Management Plan Py 5�� �FF/u e�f s�s Attachments: Enclosures: POWTS Application for Review Soil Evaluation Report 8� Site Map Project Name / Description Owner Name(s): ��,7�x�� �ri-���I��y� Phone: - - Owner Address: 63(� ON Olc,� �7 �J �fi,nF �te. (a�l Zip: SY,y7G Project Address: Govt. Lot: � 1/4 of 1/4, Section�_, T 3�_N-R O� E❑or W Q Township: �,`y��� ��Ltc� County: �uivi�w/' Project ParcellD #: 57 - 02G -2 � 3y - Dq - /!o -S t�-Oo�/ - F�Y.t�20 _ Designer Information Designer Name: l-turort 11�i c�Sevi / Phone: �/�-�- G7�i" Designer Address: ��;3(0� Co7oo� a.r� �� �/����, Zip: 5�/l�7/ E-mail: � _ � � � License Number: �C2� Remarks: Signature: L�-- �� Date: 4 Orginal sgnature required on �d coPY� CHECK BOX AS APPLICABLE CHECK BOX AS APPIJCABLE ❑ SOIL EVALUATION o s��e: �� 40' � � SYSTEM PAGE 2 OF SITE MAP PLOT PLAN r PROJECT NAME: ��o ft 9�� �p2 DESIGN FLOW: ( � � GPD � Attach design flow calcula6ons for commercial plans. PROJECT ADDRESS: C; � � � Pipe Material /ASTM Standard (Tables 384.30-3 & 384.30.5) r�G� i �,y _9 � Sanifary Sewer. � E ���� � �� � � � � BM Syrr�ol: � BM Elevation: v { � � � Force Main: / BM Descriplion: W 1 .';• �- , � � � Indicate norih by IMPORTANT: slope Gradierd(%) W�Ii Syr�d tIf appllcable): 0 ��'^ drawing an arrow Show ground elevation contours at suitable intervals. of TestBd Atee: on the appro{xite line. . ._ .. .. ... . ... _. ... . � . �.� .. . . .. .. .: .. .. ... .. . . . .. �. . '.." - .- , �� ._. _ . . .. .. � . � . _ ._ _. - .. ( . . . . .. .. .. (.'�[j :'�;'�Gr '�-' ` � V . _ �� \ �v �e c� P�r►�l- ( �� �. �b� _ ( �v � ,G , I w��� � -�-f!)�---- ...� \ r�1 �.Q('::I�'� �, VI I � .Z � � � l (�UJ��, p!/ _ _ _ _ _. _ ._, _ � /%'� ` i� � �����° � ^'� `n/'� QJ f/ _ _ _ _ _ ' _ � '� �-- r� Ao�� � , � _ _ _ I F� � - - - _ . _ _ � �� � � � �� _ _ � �v���� . _ _ _ _ _ _ _ _ ___ _ _ _ � . � _ _ _ _ r DV _ ( ✓ \ _ _ ; -�� - . _ _ � � � � � , I _ - _ - _ I _ _-_ _ . _ I WLP1000/600—MR TANK SPECIFICATIONS w�ast«,s � � WALL 3� � 150' BOTTOAI: 3" o COVQt: 5' YANHOLE 24' LO. PiffCAST CQ1CRElE PoSER HEIGFIT: 56' OA. lENG7H: 750' O.D. WID7H: 84' O.D. �---- ----�---� BELOW MLET: 4Y O.D. - UWID LEYEL 36' ; 4' CAST-A-SEA� 'lll Ir 1" CRST-A-SEAL NppiF 14,W0 LBS. INLET AND W7LET: I� � �� �� 1' CAST-A-SEAL BOOT OFt EWAL � 24' / I GASKET. C0.5T-A-SEAI. 800T OR EWAL a � g ��� `� I INLET �IA W7LET OAFFIE AND FlL7ER: ; � $ I� IIII J II "�a+�+. �E o�Tu� ro m $ � FlLTER OR (O7HER STA7E5 gE p1AR» 3 I� enFr� Ilil Il uauio cnvaan: v.sa ca�nn «anc) � � - L��——— —_ _�11�—�,—_� 76J6 GAL/�N (PUua� W,� � �m` LOADING DESIpl: 8� 0' UNSATURAIED $qL �T TOP VIEW v�iO p o�n � 0 Wm o i TANK CAN BE USED A5: �y?N SEPTIC/SEPTIC. SFPTIC/PUYP ` � a o a' vENr ors sernc/svxoN �ia�o � COVER: MIX DE9CN � (NO F1�R) �i� TANK: MI% DE9fN i10 (S7RUCTURAI FlBER) =�� CUS70MIZED TANKS �; -- -- -- FOR CUSTqI TANKS CONTACT M�SER CONCREIE INLET -- —— —— pUTLEi ;o � �� �_�" � z ¢ �n , I I� � o z 3 i �j_ i:i i " � � 0 l�__ JL--r. —J o U -- � P a PUYP PAp DRAWINGS SUBMITTED � ,"'„ FOR APPROVAI SIDE VIEW ��'�e�� — sNcrr r�o. nrrawu onrE: vaonucrs�o sv: — / `1 TM1K5 ARE YANUFAC7URFD TO MEET qi E%CEm AS111 C-1227 REpNREIAENiS PAGE 4 OF 4 In-ground Gravity Management Plan IMPORTANT: The owner of this in-ground gravity system shall be responsible Tor its perpetual operation and maintenance pursuant to requiremenis 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. Furthemare,all inspection arnl maiMenance activities shaB be perfortned by a registered POVYTS MairKainer in acxordanoe with SPS 383.52 (3),Wisc.Admin. Code. Maximum Disoersal Area Ooeratina Limks: Design Fbw= �.J� gpd; BODS 5 220 mgL-'; TSS 5150 mgL''; FOG S 30 mgL'' Insoection Checklist INSPECT EVERY 3 YEARS o rype of use o age of system o nuisance fadors(i.e. odors, user compiaints, etc.) o mechanical malFunction (i.e., pumps,valves, switches,floats, etc.) o materi�fatigue(i.e.,leaks, breaks, corrosion, etc.) o solids vdume in anaerobic treatrneM tank(s)and arry disMbution appurtenance(s)(i.e.,distributlon/drop baxes) o neglect or improper use(i.e., exceeding design capacities, prohibited adivities, etc.) o extent of ponding in distribu6on cell prior to dosing o dosing irtegularities-'rf applicable(i.e., pump re-cycling,float switch settings, etc.) o electrical components-iF applicable(i.e.,wiring, connections, switches, controls, timers, alartns, etc.) o distribution lateral or lateral orifice plugging (measure lateral dstal pressure—compare to design specification) o surface discharge of eflluent or sewage badc-up iMo structure served IlAaintenance Checklist MAIMAIN EVERY 3 YEARS (or when necessary) o Seotic and dose tank(s)shall be pumped by a certified septage servicing operator licensed under s.281.48 Wis. Stats.when fhe volume of solids in the tank(s)exceeds one-third(1l3)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 filter(sl shall be inspected every 3 years and shall be deaned when nacessary to remove any accum�dated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System mafntenance reports shall be submitted to the proper local govemment unit in accordance with SPS 383.55 Wisc.Admin. Code. Report arry componeM failure w maHunctlon to: Name aF individual or canpany: .��'i�//G' `r� �1��-u✓u:t�n�/ Phone: 7�S'�s o�yY Local govemment unit��1�`^'_ � �Z Phone: Local govemment unit address:_J7'� ^ ' �� ZIP:_ My defecWe part of this system shall be repaired, replaced,or removed pursuant to SPS 383.57 (1),Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shaU comply with SPS 383,wsc.Admin.Code. No product for chemical or physicai restoration of the POWTS may be used unless approved by the departrnent in ac:cordance with SPS 384,Wisc.Admin.Code. ConUnaencv Plan In the event that any failed Veatrnent component of this POWTS cannot be repaired,it shail be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A faNed in-ground dispersal component may be abandoned and replaced by a code-cornplying dispersal componeM in a pre-detertnined area of suitable soils. Svatem Abandonment If use of this POWTS is discontinued, it shall be abandoned in ac:corclance with SPS 383.33,Wisc. Admin.Code. Technical Specifications �� �,:���:��������: . ,��.� ������. ,�,��.��� . _ ,,�.. .�_ ....., �._�, .��.� ,K.� _ PL-525 EFFL UFNT FILTFR (�� . � ��� � T�i` �"' ) —a��+uaEa � _ x. � _ � ��' � � �� ;: ��� ,,.� j `� :�,� j, _� .a � I ._� am�ewsic�rs-- � � ato � . �caotssa+o ri . , �- � 1 i = -� .• � ,; �' � � -�:-� . C�� _ � { s-;; �' � .�! _ -:; (��—., t��:, --. :) j, , " - - , ' �i ) � ` _ �..�.-_�� �4 r� �"'��`. � .� � � t J i .I' .�.� / � ?� j-�:� � S?� � C+3�T'�''�• ��� � :�_-. �� "�' � � �� � � __ ;., ;_ 1 � �,_� - ,-. _ � �._�_ _ � ... �i �--__ \ �. ..; � ' � 1� `\ � _ , , ! �•, � Y� ' f , ; •. � ( �` � ii� �� " � ��� '� � 't�1 � ;: — ����l,,, � `_�� � � � I;. ' �� ° � I fl � �:� Rd�rf0.lStt�I�NG � .' `�' ,' , / 16u �, : % PARTNQ-30f42-5?5 .``�-: - '� ,;� , - ' •• / � �� - _ ;� NA1H11AL: ! _` � fidl9NG-POLYPROPriB� - � �—i � fiSHNI-IflPE _� I � ��� �I i I, . � --r- - —T.T�—+ f aoa�roa�rsr�re�na �� �' 1 r.- I � � _ �• � , .� ' i��� � ' —E�Rr80i�D ��j- �_� t� , l . t0et ��' _�f�tXI1QEESiBtAON ` R„��«v - -: _ � � f c�- - � ,�_ } ( � .. ��1 �, —S$OFiRC81119 s - Y M�"�'''�� l_� t � �'�. a"" '� - - �� >�� � ---'--- 1 � -- =j,, I �'Qo �—� .. �i —sOL�TE�Pts 6D1 __., � !RlN31Am i OR:��� . i-. � .,,.•, .3 �_' r,- E o ,� f - � =a �,�"Q =�. � �,. .e�'^`a t— ���'��c - ���. .."�_. �� + � �� � � �� _ i '°� � � �� � .�`�' �� •.�e ,� � .r� '�^ ' � ��� - - L ;.:s:n.r, .'�''�" . �.� w.r��� :� � i � � � ��ct �$� . . � ; - �+.�'an' " aar� ar� � _ �f mn ,� s»++i "'-- , w� n« s ���� .�`� � �, " � ' ''.,�-��. �'!� ' ( ' �^ � � ��_ ��:: II ' � �� ��. ,��� � : I POLIiLflK PL�2S f�16i CARiiGD(� � ' ' I ..,�,.� ,�,.� -.� : PIRTNa•�Ot41S15 �� � � �' _„ � � �"�- ;� �:. i MI1i6ilAl-P0.11PROPYIB� ,� ;-- y" ' � �` '=� t ".,�- .����`�$�,"'„�`�=''f: -� r L:i.-' _. ..,_:,. -::•. .. _,:... ..k,<..�,..�.�,,� : "'='�'`"����,� PRIVATE ONSITE WASTE TREATMENT counry ,,,:�, ,�. ��'�a$ , '; SYSTEMS � S awyer ���� s ( POWTS) \\)F,�_i`�,; ' -'-- INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �-� ' ��� Personal infonnation you provide may be used for secondary purposes[Privacy L.aw,s. 15.04(1)(m)] Permit Holder's Name: ❑City ❑ Village [�'Town of: State Pian Transaction ID#: �1,�, �q\�,�,� S �l� � Insp BM Elev: BM Description: Parcel Tax No: Io�.�` a�� w�� �1�� ��. � �... ��bo�, a�--q3�'--(�- 5'tiro� TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic �,�,��r _ (ooz� Benchmark � � a � Dosing - �o,...� 600 ��'►�t � � q'7.45� Aeration Bidg. Sewer � � Holding St I Ht Intet ��,gg� TANK SETBACK INFORMATION St/Ht Outlet � �3 ' TANK TO P/L WELL BLDG vENrro ROAD Dt Inlet AIR INTAKE Septic � .�25 �$� �g� NA Dt Bottom �j,(�� Oosing NA Installation Contour Aeration NA Header/Man. g ,Y$ ` Holding Dist. Pipe PUMP 151PHON INFORMATION Infiltrative , Surface 4(�7 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 W � #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav A� Conv � Aggregate INFORMATION P/L Bltlg Well Waters o G ❑ Chamber Model Number: ❑ EZFIow CELL TO ❑ Mound o Other — — ---- -- --- --- ------__ —____ 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 Muiched Cell Center � Cell Edges I Topsoil _ � ❑Yes ❑ No � �Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.) �-�,.���� 8�s�2� � �� C'�l`�CL�ty� b"1 \ --� � — -- -- - I� Plan revision re uired?�Yes 0 No �� � _ _ I `� ,�, � q o3 2 �-� � _ _ J 6 � � Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) A��ITIONAL COMMENTS AN� SKETCH SANITARY PERMIT NUMBER: ��_��__ / \ C� \ 1 �K�- � s� \ / ,�� �� \` � i ���� ��' � _ . Y, �tS� �,,,�ie�o0 . � ��Par 42 D y� , �(P���. , �� � , � , , �� +di� ��' , � � ��,k C�? 3 b1� ��� ,��� �°S�I��r. ��G�t, —� �J� �9��S �n�^c``�� ( �� `� 5� -_ ���a� � ,