HomeMy WebLinkAbout032-110-00-0300-SAN-2022-228 �
` "'"; Industry Services Division County �
� 4822 Madison Yards Way S4 W �C �i Z
� .�p,�' '=' Madison,WI 53705 Sanitary Permit Number(to 6e filled in by I
� ;>;" P.O.Box 7162 �
-- ��� Madison,WI 5370?7162 (D 3 Gi � ('� �
Sanitary Permit Application s�te Transaction Nu= �
In accordance with SPS 383.21(2),Wis_Adm.Code,submission ofthis form to the appmpriate govemmentai unit 7�
is required prior to obtaining a sanitary pertnit Note:Application farnis for state-owned PQWTS are sabmitted to Projec[Address(if different than mailing ai �
the Department of Safety and Professional Services.Personal infoimation you provi�may be used for secondary
purposes in accordance with the Privacy Law,s. I S_04(1 xm),Stats. �D��� /1�,J� f� D �f
I.AppGcatioo Iaformation-Please Print AII Ieformation �� Y�' ��v� �
Property Owner's Name Parcel#
QViA! 4 �•or� �4�`� 032 -J10- 000 - 300
Property Owner's Mailing Address Prope�ty Location
�. C�. QDK lg�a
Govt Lot 3
City,State Zip Code Phone Number
�j vt�v (�/t' s y p 9� �Y.,NL`T %, Section 3 3
II.Type of Baildiog(c6eck all that apply) � Lot#� T 3 9 N R s E
�1 or 2 Family Dwelling-Number ofBedrooms Subdivision Name
Block#
�Public/Commercial-Describe Use
❑Ciry of
�State Owned-Describe Use CSM Number ❑Village of
�I'own of �.I,J 1 K T`C '�
III.Type of POWTS Permir(C6eck either"New"or"Replaceme�"and ot6er applicable on line A. Check one box on line B.Complete line C if
a Gcable.
A' ❑ New System �R�Sys�em ❑ Other Modification to F.�cistmg System(explain) ( p )
❑ Additional Preheatrnent Unit ex lain
g' ❑ Holdin Tank In-Gra�d ❑ At-Grade
g ❑ Mound ❑ [ndividual Site Design ❑ Other Type(explain)
(convemtional)
C• ❑ Renewal Before ❑ Revision ❑Change of Ptumber ❑Transfer to New Owner
ist Previous Permit Number and Date I ued
Expiration l'���� y '
IV.DispersaVTreatineot Ana and Tank Informatioa:
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation
o v . � Y•�9 sa o ;�� �9.�7 '
Capacity in Total N of Manufactu►er
Tank Information Gallons Gallons Units p � o � o
New Tanks Existing T�ks � o � � « � � �
a. U rii y rn w C7 0.
Septic or Holding Tank �!� x0 �f� I �� �/� /�
Dosing Chamba
O
V.R�poasibility Stat�eat- 1,tic oadersigaed,assamc respoesibility for+estatlatios of tre POW TS s n oa t�e athched plans.
Plumber's Name(Print) Plumber's Si ture MP PRS Number Business Phone Number
IM11�t I�VIoK o�t�•► \7� d��S/6 4 Z�S-.tGG - 305<0
Plumber's Address(Street,City,State,Zip Code)
y 3 y� N L.��e tar�cF�- IR o�. t,,J t H.�".a.�. W S S� Q 9 G
VI. o tylDepartmeot Ose Onty
b � Q Disapproved �� ����� Issuing Agent Signature
� �,� � yc�,�a a(c�f�� �/f
❑Owner Given Reason for Denial
Conditions of Approval/Reasons for Disapproval
� -t'(� f%Z'Z _ t-= S 't� �' ` ' � `�
' � ,
� i �Y.: �._ .,..... . .T�' ��,
� � Ic � q . , � _ .� _ .__
� � ::��,'' �-,�+3 fl � Z��`-_;-_.,
�R � �
�s-� �a��3 .N� �� ,� 3M�� �,
� ,. _ , ;�.�,
Atqc�te com for t�e system and sabmit M t�e Covnty oely on paper not less t6an 81lY,i 1'l:iir�hes ., k���,�>
C S \ ��-- l S� NO R�FJNDS AFTER 3 asc�g
ISSUE OF PE�iMr7'
PAGE 1 OF 5 �
In-Ground Dosed-Gravity Plan
Index & Cover Sheet
Component 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 Plan
Pg 3 of 5 Dispersai Area Cross-Section & Pian View
Pg 4 of 5 Pump Tank Specifications
Pg 5 of 5 Management Plan
Attachments: Enctosures:
____ __--------__ _ _ -- -----_______ _ __._ _-----_ ---._----------
Pump Curve POWTS Application for Review
�.. - ---
Soil Evalu�tion Report & Site Map
Project Name / Description
Owner Name(s): t�., ;�+•� Lor,' ('�,�y Phone: - -
Owner Address: 5oetS,v Gi�i��v�rJ �o� �cJr.s.�.� l,JS Zip: S�f�PG
Project Address: So,"E.S ti li'�y�✓ R� G>�.�` L.vZ� �rr�rG
Govt. Lot: �_ .1/4 of �� 1/4, Section .� , T�9 N-R�E ❑or W,�
Township: l.t)f�� County: �u-J'�l�
Project Parcel ID #: 0 3�L - //o O .. b a 3(Z o
Designer Information
Designer Name: 1'�n�'lc� IMoK�,C� Phone:��S -d(oG-�e�`.�,��
Designer Address: �/3Yo N L,9.�it. W<<.�,�� �- �-'��-� Zip: �Y �¢G
E-mail: Mo•��l✓w,b:wr � �."wfrr�y�Gl -Nef � , „
License Number: /N�?�a S� (o � �,�._,
Remarks: � �
��P 0 2 2022
D
SAWYER COUNTY
ZOfVINC',i qpMINISTRAT101V
Signature: ✓ Date: 8'-��'- ZZ
Original signature uired on each submitted c�y.
S���Pf�� P1� SIZING INFORMATION
QUINN AND LORf CHADA p/�LY FLOW=300 GAI.LONS
PO BOX 188 SpILAPPUCATION RATE_.7 GPD/SQ.FT.
UVINTER,WI 54896
5Q25N CLAYTON RD �ORPT�ON AREA REQUIRED=429 SQ.Ft
ELEVATIONS
BM=100_0',TOP OF MANHOLE COVER ON PUMP
N TANK
SCALE IN TESTEDAREA 1"=40' B-1=1032'
a-2=�os.a
( ---� s-3=�oax
SYSTEM RANGE=1�.45-99_T
SYSTEM EL=99_8'
S!T OUTLET=96_45'
LENGTH FROM OF FORCE MAIN IS FROM P/T TO
SYSTEM IS APPROXIMAIELY 110'.
DCISTING
COMSlNATION
P� TANK
DR WAY
BM
HOUSE
¢�Sb,�S N CLAYTON RD
A4';°�• �o�t� o wEu
1�� - r"`°
�
�
�
�o�:.a t
t D3.o THtS Ai2EA NOT
'QL;.�. . a� . ,�,k.C�e.�. S DRAWN TO SGALE
Z.' s
�.��d
Sov� �•
.
. �
P/L
__ __ ___ -..
---___ _ � zt o3z1 I 000d3oo
P°`'`
c.�a�= ���� Sr ��r 5 3 3 '�3 9 �vQSw
IN-GROUND GRAVITY DISPERSAL AREA SepticTank(s)Manufacturer:
��ir��� .�✓t/G
Uniform Eievation Trenches with EZ1203HP Bundles SepticTank(s)Volume(s):
3-ft Trench (down-sizing credit)
�L gal gal gal gal
Effluent Filter Manufacturer:
o r,G� C o
� min.12" Effluent Filter Model#: �rt 1'��O !-�Q�
GeOtextile � (tyPicaQ
Cover
soi�covE� TYPICAL TRENCH
'� CROSS SECTION VIEW
min.trench ;
depth L .�R (No Scale)
«P"��� J� OBSERVA710N PIPE DETFaIL
/ p•• ' (No Scale)
System Elevation=���. � � Screw-Type o� •�,, , Finished Grade
�ty���� Provide minimum 3 ft Slip Cap poose} •"� (mulched&seeded)
separation between trenches. a"0 PVC Pipe ` * �;; 7opsoil Cover
7op af pipe to tertninate ,' (min.1'9oot)
at or a bove f nished grade
(4)1/4"-1/2"%8"81ots
TYPI CAL TRENCH (Show location of iniet/outlet pipe connection on plan view.) ��'o ��n
PLAN VIEW AnchoongDevice 'su�at�
4n nt Observation pipe ahall be instalted
(No Scale) Perforated�Lateral atjunction betwee�two�nits. ft
QbservaUon F'ipe ������
(tYPical) (tvp�ca�)
�- - — — — - -- - ��- - - -- - - -- — �
I -- -=— -_-_._._=- =--__ _- ==_ =__=_-= -_—=_--= l A= 3.0 ft �
L - - - - - - - - - - - - - � - -��— - _ _ - - - - - - - - - - - -- - - - -1 criP���� m
r" B= ft �{ W
(tY��q
INSTALL PER TRENCH: EZ12Q3H Bundle Q
O (iyPical) (�
� 10-ft bundles @ 50 flZ EISA/unit= �� ft2 {mfd by Infiltrator Systems,Inc.) _`
lnstall pursuant to manufacturers instructions.
+ _,_ 5-ft bundles @ 25 fi� EISA/unit= _,,,.,_ ft2
= Proposed EISA per trench= ��„_,,. ftZ Required Infiltration Area= y�� ftZ DiStributton Method;
x �,_,,, trenches = Proposed Total EISA = �� �2 �sS��� ���`�
,
- - ���
PAGE40F5
GRAVITY-DOSED
S€PTIC / PUMP TANK SPECIFfCAT10NS
�No Scale)
4"0 Vent Pipe
>10 ft from
Building Eiectncal must compiy wilh
12"Min.or 2.0 ft above SPS 316 and NEC 300
EstabGshed Fiood ElevaY+on Weatherp�oof Extend mantale riser as necessary
(rypicat} Junctiort 8ox
Approved
Vent C»p Approved Lodcing Manhole
IMPORTANT: wilh Wami�g Label Attached
(�YPicaf)
Anchor tank(s)as necessary --Conduit
pursuant to SPS 383.43(8)(g) a^Min.or 2.0 ft above
Esteblished Fbod Elevalion
(�YPical)
�Airiight Seal \I/
Finished Grade � —��r
'" Quick Oisconned
.
18"Min.
CAPACITIES @ gal/in : � � t�vp���>
a �Depth{in) Vofume(gai)
A �7 �� *� Weep �Approved Joints wilh
Hole Approved Pipe 3 ft onto
B 2.� q Solid Ground
LCl V ,� �tYPical)
� •
0 Alarm
� /2 �� .�_ �—On
� PlJMP-0FF
i t��
� �mp ELEVATION = Z �S ft
*Pump Tank Liquid Level = Zp in �--off . �
° INSIDE BOTTOM
Force Main Diameter=��Z in c e"-�` Q
,
ELEVATION = /�ys ft
Force Main Length = �I D ft 3"Approved Bedding Matenal Benealh Tank
Force Main Void Volume =� gal
.�
(C]Total Dose Volume TDV = �s gal/dose
(<0.2X design ilow+force main void volume)
Vertical Lift=__�� ft
PUMP TANK: SEPTIC TANK(S):
Volume =����gai Totai Volume = Boo gal
� �
Manufacturer. �v�Cv� ��vC Manufacturer(s): �u��4.�� �'�v-r_
Pump Manufacturer: �id� �.�5
Install approved effiuent filter at the septic tank outlet
Pump Model: �t�`7�/ (See attached pump curve.) immediately u.��stream of the pum� tank inlet.
Controls/Alarm Manufacturer: S�e Q{�,n�av5 FilterManufiacturer: d(r�n�a
Controls/Alarm ModeL• `rA„ � ,�..1�r�- ( ��— D �
Filtcr flAn�ict•
PAGE S OF s
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 shali be considered a human health hazard'rf 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= ,�O o gpd; BODS 5 220 mgL-'; TSS 5150 mgL"'; FOG 5 30 mgL''
Insaection Checkiist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance Tactors(i.e.odws,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 dishibution appurtenance(s)(i.e.,distribution/drop boxes)
o negleci or improper use(i.e.,exceeding design capacr6es,prohibited activrties,efc.)
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 piugging (measure lateral distal pressure-compare to design specificaGon)
o surface discharge of effluent or sewage back-up into structure served
Mai�tenance Checklist MAINTAIN EVERY 3 YEARS(or when necessary)
o Septic and dose tank{s1 shall be pumped by a certified septage servicing operator licensed under s.281.48 Wis.
Stats.when the volume of solids fn the tank(s)ezceeds one-third(1/3)the liquid volume of the tank(s)a
as required by Iocal ordinance. Disposal of contents sha11 be pursuant to NR 113,Wisc.Admin.Code.
o Effluent flker(s1 shall be inspected every 3 years and shall be cieaned when necessary to remove any
accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12
months.
System maintenance reports shall be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc.Admin.Code. Report any component fatlure or malfunction to:
�
Name of individual or company:.,M1o���___�.�w�4/ _ Phone: 7�f'.74G '_3e'!o
-�--------- —
Local govemment unit: �4..y� �,V/i..L Phone:-y/S-G 3f� -FJ�S"�
—�_
Local govemment unit address: /Ob/0 rYUt�'n Sf. �e.y�,� ti/t ZIP: SY 9 y 3
Any defective part of this system shall be rapaired,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 POWTS may be used unless approved by the department in
accordance with SPS 384,Wisc.Admin.Code.
Continaencv 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 discontinued,it shali be abandoned in accordance with SPS 383.33.Wisc.Admin.Cnde
(�c�out�s �lMPs sui�ner�ibk
E�luer�t Pump
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PE � �
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�np—6ene�at 6�e1�ak ■Co�m�ion res�s�t
• Dimd�arge: ll�I�T ' �1e P� a�truntlon,
• T� 1Q4°F(4Q°Q - 6Q Her1i ■Cast ean body.
�aor�c�when • 115 vad�s ■���d
- fi�►�ged. • Bu��themat o�loa�d po- a�ves
� • soi�s!e„�r,� 'J�' ce�on w��c t�c :upper sie�e aid fowe�
rt�aodmarn spF�re • C�Ss 8 6�on. heavy daq►ba9 b�ar9
/�PttCATiONS •floet���de a ' �-�d desigiL aor�sbucLioa.
' �►��s� ■ilAo�ar is pemtanetp�r
• Manua!mo�lels a�abte shaR.
�e�jr d�igncd ford�e �ubi�fur e�aended
�g u� � �9�+9�� PE31 Mo�or; seyicP�e.
• Maitid S� P�►�d�t or aeve • 33 F�,3000!�M ■Powaed far mn�uara
' �Do�ng S�st�ns PBt P� • 12.0 Nlao�nurn a�s �
' �U*aming� • INmdmam I�ea��2S'Tplf� Sl+aded pare de�gR �""o'"'y'are t��e
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• M�wm�TDH • PSC�design � �7���SdtW�
PE�t PumR PBt lla�or: t 5i�s-15R,t�ree prong
M�n�t�jr.70 6TN1 • SO F�.344Q t�N
' �1�3T 7DH • 95 Il�odertrom anips ������•
�tEtHts �E[ • PSC design ■�s�J{��rhon,
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PR�JECT; 4154 123rd STREET ����
ru _m�� N.P.C.A.c�Rnnco aunr
a HUFFCUTT CHIPPEVA FPLLS,VI 54729 �„o� —��
I,250/]50 GALL�N ��^
� PUMP OR SEPTIC TANK �7157 723-7446�(800)924-1516 ��� MEMBER OF:
C 0 A C R E T E.�A rr FAX(7I5)723-7111 r rwrhuffcutt,con ��o� rU➢aNPi k WSWNSIN PRECASi CONLREiE ASSOqAlI0N5
'""'l� PRIVATE ONSITE WASTE TREATMENT co�nty
,-.<,--�-f���>�
� � ,.,,
��� y� SYSTEMS
r,� , , ,
" DSP '��' Sawyer
`�>;>�� s /.�; ( POWTS)
`�;�_--��i
�''�,"-"•'y- INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION 22 ���
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#:
Q�(�n d�p'n �'�ad�a �J���(-' —
Insp BM Elev: BM Description: Parcel Tax No:
�oo.o' o'� ��su' �r� q„ M�^��N� v3�- (�o �oo -c�3o�
TANK INFORMATION q� �ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic � ex�sfi�y _ �.'Sp Benchmark (d�.o r
Dosing �,h � --��
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht outiet
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic NA Dt Bottom ��;,� �
Dosing NA Installation
Contour
Aeration NA Header/Man. �p0,�'
Holding Dist. Pipe
PUMP 131PHON INFORMATION Infiltrative �
Surface 99.'8
Manufacturer � � Demand Final Grade
Modet Number ��(� �pM �� 4 ��- �C�.9' �
TDH � Lift Friction Loss Sys Head TDH Ft
Forcemain L �(pp' Dia �� Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W 3 L � �� #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate
INFORMATION P I L Bldg Well Waters � IGP o Chamber Model Number:
❑ AG �( EZFIow
CELL TO kS� }.�o p' ,t.�uo N ❑ Mound � Other
— -- — -
---. --__— — _ _
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 Ed es � Topsoil ❑Yes ❑ No � ❑Yes ❑ No�
C O M M E N T S: (Include code discrepancies,persons present, etc.)
���/l� ��� �� I��
� �,� --� C���/.
Plan revision required?❑Yes 0 No
_
�3 �$_ a3 � ��� 6�� (�
_�
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AOOITIONAL COMMENTS ANO SKETCH
SANITAAY PEAMIT NUMBER: oZ„� - ���
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