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HomeMy WebLinkAbout024-741-30-5417-SAN-2022-191 � Department of Safety c°""ry � O$ & Professional Services, SQ�'i', � San�tary Permit Nw er(to be filled in by Co �= Industry Services Division �3�l� � � State Transaction Number � Sanitary Permit Application � In accordance with SPS 383.21(2),Wis.Adm Code,submission ofthis form to the appropnate govemmental unit ^— � is required prior to obtaining a sanitary permit.Note Application forms for state-owned POWTS are submitted to Project Address(if different than mailing addi the Department of Safety and Professional Services Personal information you provide ma� be used for secondary _ J � purposes in accordance with the Privacy Law,s. I>Od(1)(m),Stats �C �C � 1� ����� ��, I.Application Information-Please Print All Information Property Owner�s Name Pazcel# �,�4 . 7��_ 3U' S �-� �vl c- � �e�e�r- I ��'1 D er-�15�-� i �� o i -7�t[—3 v -S �k Property Owners Mailing Address Property Location � Z22-(: U(�k �l.lt��' �✓: Govt.Lot�_ City,State Zip Code Phone Number 4`1 l�,s�.C:�n'� �-j`� 5 Z�J�� ��.S''�{�vZ-�blv.3 �°� '/o, Section � � II.Type of Building(check all that apply) Lot# T � ( N R 7 If�I or2 Family Dtielline-NumberofBedrooms .� � Subdivision Name Block# ❑Public/Commercial-Describe Use ❑City of ❑State Owned-Describe Use CSM Number ❑Village of 3�'l� �'To�m of _��_i�•111- l.l_%�� III.Type of P0�1"TS Permit:(Check either"Yew"or"ReplacemenY'and other applicabie on line.a. Check one box on line B.Complete line C if a licable.) A ❑ Neti�S}�stem �iReplacement S��stem ❑ Other Modification to Existin�System(explain) ❑ Additional Pretreatment Unit(explain) B. ❑ Holding Tank [�ln-Ground �n:I(�� ❑ At-Grade ❑ Mound ❑ Indicidual Site Design ❑ Other Type(explain) (conventional) C• ❑ Chan�e of Plumber List Previous Permit Number and Date Issued ❑ Renewal Before �Revision ❑ Transfer to Ne�+O�rner Expiration Z Z- ( � �/2..//ZZ IV.DispersaUTreatment Area and Tank Information: Design Flow(gpd) Design Soil Application Rate(gpd/sf) Dfspersal Area Reyuired(st) Dispersal Area Proposed(st) System Elevation � •� ' . � SZ'C S�r /00: �� Capacity in Total #of Manutacturer Tank[nformation Gallons Gallons Units � � o � u New Tan}:s Esisting Tanks •C° � y ' v v �' '� � � � v � � � 0 � U v� � ri� ir: C7 a Szptic�-Eolding Tank i b C C !�� t (,(,' E Dosing Chamber (�G G (�iCC �- �— CZ:�7l d. ._. i4 h1 i V.Responsibility Statement- [,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's Signatur MP/�SNumber Business Phone Number �G'c��v� C�u��-� (, .7S?S"/ 7 i�= 7 r�� 33S�r— Plumber' Address Street,City,Smte,Zip Code) � o _ �cx: �� ��t� ws s��zr VL Co ntv/Department Use Only �.,A ❑D�sapproved Permit Fee Date[ssued [ssuing Agent Signature $ � �� �� ��� �(�_ „_ _' � ❑O�+ner Gi�en Reason tor Denial ���wj Conditions of Approval/Reasons ti�r Disapproval �,+ a ---, ,. D � � � c��� ���!�a�._.,�.yn.���_ � ������� ��+ `�; �,'� � �� � y �� ��.. � �� � �� rti�j 3 _ � �- � i �"�' a�_�� N e.� w a���._'� aq� AUG 0 � 2022 ` �;..: SA1l�`YER c�)t�����Y Attach to complete plans for[he system and submit to the County only on paper not less than S t�2 x 11 inches i " � SBD-6398(R.03/22) NO R�FJNDS AFTER ISSItE OF PCRMIT �(Bo31 ' PAGE 1 OF 5 In -Ground Dosed -Gravity Plan Index & Cover Sheet Componenf Manual Design References: In-Ground Soil Absorption for POWTS Version 2. 1 (May 2022-2027) Pg 1 of 5 Index & Cover Sheet Pg 2 of 5 Plot Pian 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 Soil Evaluation Report & Site Map =-k � � =L: � �,,. �.t t'`t � �Si cv'"� !C� �t 1�C S Project Name / Description Owner Name(s) : � v-« � �uev-lU I�vu:�rnsc�tc I a Phone: 7� � - '-��z - ��3 Owner Address: Z2Zo C�G� U c� L� � fl�Y: (Y1 u5cc�ne : 1� Zip: � Z7 l� / Project Address: IUI aj � -�'; l �.�.- �c«, lQ�{ �tcA�;�- �,vo�,�,�c;Q , W �i 5�� �-3 Govt. Lot: '� �r � _1 /4 of 1 /4, Section 3 � , T �-{ I N-R �7 E ❑or W,� Township: �ou�,� �L. ��e. County: � cu.c,� G e.�' ProjectParcellD #: � z� - 7�fl - � e - S�F17 �- S�F � � Designer Information Designer Name: `jC3.�c�n � u�-�-�( Phone: ? I .i"� - �74d� - �js3 � Designer Address: 'P� Z� � �c� C� � ��� �� z �tis Zip: SZ{£! 2� E-mail: �w. �_ �c� G�t�y �rc� S ; � �v� License Number: �; `?S7S/ Remarks: Signature : Date : �- �Z Original signature required on each submitted copy. € �-- t . - F: ��_.�.�=0:<aS�_.��._,����'�_=. C-._C�?O;<45 A?���JrA�L=. f � � SOIL EVALUATION o '�a12: ���=a0' so 80 � SYSTEM PAGE 2 OF SITE MAP PLOT PLAN . PROJECTNAME: ��o�9,;d> >a, oEsicr�F�o��i 3�` cFo ���`���,�� � ��� Attach design flo�r�calculations for commercial pians. PRo.IECT ADDREss: Pipe blaterial!ASTM Standard (Tables 384.30-3 8 384.30-5) c +` ��j C Sanitary Sesver, � J�G�"� U� J BM Symbol: � EM Eievation FT Force tvlain Z �C�t"`1� � BM Descnption: ��'+' �<-L=�-'��L- �`� Indicale north by INIPORTANT: Slope Gradient(%) G�d �r/ell Symbol(if applicable) � drawin9 an arrow Show ground elevation contours at suitable intervals. of TeSt2d Area�. on the approprite line. ow���. ' �2«_� �c��-�-� ��N������r.��. F'����� � � __I o S. r- .----- ,� ,Z� i�Y w�-�, r-��_ - -�_}ZL O N - i L T�'� ,� Y ; �.�, . __ . ___ -- --- - � - - _ - -- _ _ :_ _ _ 41-,� �cc� -��-� � �� � y ���z /� _ csn-- r /z� i-- - �y -- � �,��. - , ! � , � , � , -- --� _ -- - - _ - - - ;-�;�-�-�-���r �� � � ��^�'�..� � S ----___ �-�---- --------- _ ____ _ - -----� -- -- -- -- - = --= -- - - - - � � � - --- - . � �_ �_ c� zy_�� _1�3'6_5��',)_�__� ,OZ�1�� �1 13US�--I 1 -7 ; ; � I � � � !-,—!LL__ �----- --- - - -- - __ — , _�_ __ _ �___ __ -- ---- - , , t--; , � �,U,c�-'y ' _- - _ _ ?1;:rU_�'f ?>=�--,—� ; � -- - ------- ---._ _ - -- • - , � i I I � - --- - - - [�- - --- -- -- -- — --- - - _ , _ � i � , � _ , � �--- _.-- - _ . ._ _— :`b --- � . ��. �;,�,, _ S��". c�► � �l e.'ts;� i � � — -- - - — --- ; , �_ _ � 3 -- �-- h- ------ , -- _ - ---},� , � : ; ; , � , I � � , _ . 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I �. � � . - . ��.� . , , i i , J _ _ - =- _ _ - - - --- - - - _ _ - i � �(. _Y��.c �.� /�'�1n i i � ' _ _ I —; _ _ �.A _1-�J cct�2�L_ __ � — -- _ . _ _ _ . _ . �\ �C� / � __ �__ _ _/ � _ �_ � _ � _ _ ' �t�l�L,, '� 6r1-0 t yr' , �O l J l� _ _ �}-Y . _ . _ _ z•,�i,t'LL-�.A-1�1 ._ _ _ _ � � _ rILZZ ���� - I ' �� _. � _ r---�_ �2..�- _ . _ _ , � , , � , _ .. --I __ _ _ _ _ _ - �v►Suf�c� � ; --- __. ,_ _ i , �c�; �,€15;� , . • � ; ' � �oot���aC _ ;_ _ '-- --- - � �_ - i j i __ � o - I- ___ __ ----»-'. _ . .=__ -:-_: _ . ���.� � �,7 S'75'1 � � �,/,Zl�```z�_-.-- /� ���L2 f`�'�GrtS�Qil \'_ CX�C� J� � _ _ . -� � L �c� � I � J IN-GROUND DOSED-GRAVITY DISPERSAL AREA Uniform Elevation Trenches with EZ1203HP Bundles 3-ft Trench (down-sizing credit) � mm.,2• ceO�eX"'e I I cryc��ao TYPICAL TRENCH co�e� soi�coveR CROSS SECTION VIEW 12� (No Scale) OBSERVATION PIPE DETAIL min.Vench depth (No Scale) (typit'al) L —r -- .�`' Screw-Type or Finisnatl Gratle Slip Ca0(loose) (mulchetl 8 seetle0) /100.66 4^0 PVC Pi To �co�a, S ystem Elevation= ft. � ro o evna.lna e l a,�� � ' Provide minimum 3 ft Po Pipe (bpical) a�o�am�e r���snea 9�ea separation between trenches. z �4��/@�sb z�nsiou TYPI CAL TRENCH (Show location of inlet/ounet pipe connection on plan view.) n��no��9 oa��� i�nn��a� PLAN VIEW Su�d`� (No Scale) 4��� oosaNauo�o�oesnanoams�i�a a�i��c�o�oa�wee��wo�mn. Perforated Lateral Observa[ion Pipe � ft (typical) (rypicap —— Irypicaq r--- ��------------- ��� � ______ ______'_`--`- � A-3.0 ft � ___ __°'___ ___"_=_ �---------------�� -----J (tYPicap G� --------- I- a= 5o ft - � m (typicai) �J.� INSTALL PER TRENCH: EZ1203H Bundle � (typical) -n 5 10-ft bundles @ 50 fl'EISA/unit=250 g= (mfd 6y InNtretor Systems,Inc.) � Install pursuant to manufacNrers instructions. + 5-ft bundles @ 25 f�EISA/unit= ft' =Proposed EISA per trench=250 ft' Required Infiltration Area= 500 ft' Distribution Method: x 2 trenches=Proposed Total EISA= 500 ft� branched manifold RESET PAGE 4 OF 5 GRAVITY-DOSED �c�', SEPTIC / PUMP TANK SPECIFICATIONS ��;��� (No Scale) 4"0 VentPipe >10 fl from � Building Electncal must comply with 12"Min.or20ftabove SPS316andNEC300 Established Flood Elevation Weatherpmof ' Exlend manhole nser as necessary. (typiral) Junction Box Approved qppmved Locking Manhole Venl Cap wi�h Wamin Label Attached IMPORTANT: s Anchor tank(s)as necessary I � (ryP���� pursuant to SPS 383.43(8)(g) ----co�a��� a��M��.o�2o fl aoo�e Es�ablished Flood Elevatian (typiral) �Airtight Seal Finished Grada I �uick Disconnecl 18"Min. CAPACITIES @ ((p,7(o gal/in , y , (�rP���1 • 4 �Depth (in) Volume (gal) A �p, J �7 � V , � * I Weep � `Approved Joinls wilh Hole qpprovad Pipe 3 ft onto B 2.� 7j7j. �j Z q SolidGround (typical) [Cl S.S qa, ly I � 0 A�a�, � [(� f�'7 4� e �—o� � [c] PUMP-OFF f- * + P°mP �_on ELEVATION = �� Q ft Pump Tank Liquid Level =�in � �� ° INSIDE BOTTOM Force Main Diameter = Z in c°�Le`e � B'°�k ELEVATION = �'7, (j ft Force Main Length = i'� D ft 3"Approved Bedding Matenal Benea�h Tank Force Main Void Volume = �7 7 I gal [C] Total Dose Volume TDV = �'7, 7 I gal/dose (<02X design flow+force main voitl volume) Vertical Lift = I3: �� ft PUMP TANK: SEPTIC TANK(S): Volume = (vUC� gal Total Volume = �(�Od gal Manufacturer: (.eJ I �S �/'� Manufacturer(s): l.�=i ES� Pump Manufacturer: C�6�2p�D�n �� Install approved effluent filter at the septic tank outlet PumpModel: PfS .3 �seea�ca�neaP�mP��Ne� immediatelXu�streamofthepumptankinlet. � Controls/Alarm Manufacturer. S�G Filter Manufacturer. C'jV-ec'1 CO Controls/Alarm Model: /CI �� Filter Model: �T v� Z z Float switches containinq mercury are �rohibited. PAGE40F4 In-ground Dosed-Gravity Management Plan IMPORTANT: The owner of this in-ground dosed-gravity system shall 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 performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operatinq Limits: Design Flow = 300 gpd; BODS <_ 220 mgL-'; TSS <_ 150 mgL-'; FOG 5 30 mgL-' Insqection 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 applicable (i.e., pump re-cycling, float switch settings, etc.) o electrical components- if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure—compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the 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 filter(s)shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance repoRs shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: AIICII)/ R8SfT1USS@Cl Hc SOIIS, Inc phone: 7�5-798-3355 Local government unit: S8Wy2f COUrlty Z011lllg Phone: 715-634-8288 �ocal government unitaddress: 10610 Main St. #49 Hayward, WI Z�p 54843 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or repiacement of failed or malfunctioning components shall 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. Continpencv 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. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 353.33, Wisc. Admin. Code. � �'�" PRIVATE ONSITE WASTE TREATMENT county ,__,;\,. �i �yl� SYSTEMS ���� n g� Sawyer �\���l`, ( POWTS) \',ss'°�,"� 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 Law,s. 15.04(1)(m)] Permit Holder's Name: ❑City ❑ Village [a�,Town of: State Pian Transaction ID#: L'n''��-'�e.v�-� I�,.,oe.r,.asa„��► ��h� t��'� — Insp BM Elev: Description: Parcel Tax No: �o���` -� el,e�c.._ o��( -��t( -- 3c - �"=y 7 TANK INFORMA ION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic w�� _ �ppo Benchmark �o.o' Dosing _� o _ Aeration Bldg. Sewer — Holding St/Ht Inlet q0.IS� TANK SETBACK INFORMATION St!Ht Outlet �'9,�'s' TANK TO P/L WELL BLDG VENT TO ROAD Dt inlet AIR INTAKE Septic }�a` ��� (�` �--�a, � NA Dt Bottom ?,IS� Dosing ,� k k c, NA Installation Contour Aeration NA Header I Man. �o i.1�" Holding Dist. Pipe PUMP/51PHON INFORMATION Infiltrative � Surface ��°'7� Manufacturer �� � Demand Final Grade Model Number 53 GPM ���� '�T Ibl•�tj� TDH � Lift Friction Loss Sys Head TDH Ft Forcemain L t�-qo Dia a`� Dist.To Well DISPERSAL CELL INFORMATION DIMENSIONS W ',j L � �� #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav Conv ❑ Aggregate INFORMATION P I L Bldg Well Waters � GP ❑ Chamber Model Number: � EZFIow CELL TO � -�- � �}-Sb �-5'a� ❑ 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 i Depth Over Depth of -- Seeded/Sodded Mulched Cell Center � Cell Edges Topsoil ❑Yes ❑ No �Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.) s� s�N �2 -��'� ��,,) ���ll,�/ � 1 aq (�.� a�- � �.o — - Plan revision required?❑Yes � No p� �-� �3 � � � � �� � '� Use other sitle for atlditional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) A�OITIONAL COMMENTS AN� SKETCH SANITAAY PEAMIT Nl1M8EA: �-�--I� k i� fi'o ►M��. C.�Ic�, �,.� �c�. -���'`� . . . . .... . . . . �� . . .__!__ .! :. . :._ . ; . . � ____;._. _�...__. '__.__�-.. �.._.._.�.___:_... .___ _. __._ ___..4 � �� `�r� . . . . , . . . . . � ��� � . . . . . . . , � c�� T Q"'` � � ��`� �� ��� ` ' ' ' I ' - - --- , , - - - � ._.__ �__., . ;.__.; _.,__ � � , ��L ; � _ � -- ,_ :._ _ . ,..__... __�.. ... _. ,._ ,. _.., � t ____.. 3 ' ,.Q�. j , , , � w' ' �_ 600 . , _r- - , - , _ � --- -_ - � � ��o , , , - � ` )�b �' �.�I� � ' � � � � V � ��°'°�'� � ��� d.�>�...wQy ��� �`I�.�QY r�C, A7��� � �m. �1�.(zc�) �4� � � 9� / � � � �e� � k �G'�� �\ � �,� �, � �, GQ�SR— � �; � R � �