HomeMy WebLinkAbout020-639-25-3302-SAN-2022-262 J„��,-_- Industry Services Division ���Y � N
,p�y 4822MadisonYardsWaY 'J4k� L.✓� �
�,��.t' Medisoq WI 53705 Sanimy�ric Number(w x e�kd ie by�
. . : ;�! P.O.Box 7162
���'%�...'=�'r;� Madisoq WI53707-7162 �0 3� o��� �
Sanitary Permit Applicarion StateT�an�ctionNumber �
,
In eccotdance with SPS J8321(2��s.Adm.Code.submission of ihis form to ihe a�riate govemmental�mit �
is required prior ro obmining a a�itary pemiit Note:AppGcatian fotms for sleto-owned POW1S are submitted no Project Ad�ess(if diffeiwt than me�ling e �
the Dcpazlmmt of Safety md Pmfrsvonal5wim Pecsoml infolmatiou you pmvide may be used for sarondmY
p oses in acco�dmce with the Pri Law,s 15.04(1Hm).Smts. �' l� �
I.Apptiat5on Informetlon-Please Pr3ut All Informatlon
�Owner s Name Pucel#
on41 P S5�- 0 0
PIOPCM1}'OWIIC!'S IY�B�IIOg AAA(C55 n n P�Optli�LOL0I1��
s `�� ��fSC��'�rX (X ^- •
Ciry,Snh ZipCode PhoceNumber
_ `��P� �.J� SL�DZIrJ SLrJY��Y.,Satiw ��
II.Type of Bolldisg(chedc aR t6at appty) Lot# T � N R E W
�Ior2FemilyDwelliog-NumberofBedmoms� ^ SubdivisiouNeme
Block#
r--
�ublidCommercial-DesctibeUse ,�
ity oF
tete Owned-Descn'6tUse CSM Nmdw illage of -^�
.�- �fowm of 0 V 1���(
7II.Type of POWTS Permit:(C6ak dtLer"New"or`�RepiacrmmY'snd oTher spplksbk on line A Cheek ooe boi oo dne S ComplNe line C
a licabie.
n. ❑IVew Sys�n �acement sysaem ❑Dtl�er taoaiscetion ro E,asting symm(e,cplem) naairionat Metree�cut umt(«plain)
B. ❑Fiolding Tadc �lo-l'nound �1t-Gade ❑Mound I�div7duel Sita Desi� OtherType(explain)
(convwriooel)
C. ❑Renewal Before ❑Revision of Plumber �['�sfer oo New � �O�p�����«
�P��� u h I�C. ?
IV.DisperssllTrea�eot Ara and Tank[oformatlon: Ow �n� S ;n $
Design Flow(gpd) Dai�Soil Appliation Rete(gpd/s� Dispe1sel Nea Requi2d(s� Dispasal Area Pmposed(s� System ElcvaGon
cx> �S � � '� �3.5�
Cepacity in Topl H of Af�u�c�ucc ,
Tenk Gifomwtion Gall�s Gelloaa Unin �u c�$ q �
NewTmYa ExoUogTmk V y N x_ m
&u 'v, i�C7 'a
SepocaHoMingTmk C�(� � 5 c�W (e u�c�
v
Dwiog ChtmM �
V.Respoosibllity Shtemeut-4 We aade�ed.aname reqrondb0ib'for iapa0�tlou o(tLe POWiS�owa oe the amc6ed ploos.
�Plu 's Neme(Prinq PI ' Si�anrce MP/MPRS NwoLer Business Phone Nmnber
��� �� � - s� ����� ��s-a�� ,�s��
rt„ro��s ada�cso-�.c�ry.sma.tir c�) / �
SC��`�— Y� .S'�l\ � L!/l/I.��P/ � �S��O
vc.c ootymepa��r u�o�
�A ❑Disappmved Pamit Fee Donte Iawed Isauing AgeM�Si/g/u�anue
�9'✓ ❑Owner Givm Roson for Dmial s I��� `I a-a-I2o�- �.I t�yt-�7.�t/u-
Conditions of AppmveUReasons for Disappmval
��iG'��� a�aa-/a� j� �_' '` ;'�`,
rr �c,a� ���� SEP 19 2022 �':��
CS� �o�— �V � � fJP.w Worlcl #3522 i----- �
�4f SlaW`i ER CQUNTY
AmN m eemple�e Ph.�fer t6e spOm aoe ao6mit b t4 Ca�a1y ool��n�uper oot Im th.s 8 Vi t 1l
a��i�s
S8D-6398(R 03/21) NO REFJNDS AFTER
ISSUE OF P�RMIT
' � PAGE 1 OF 4
In-Ground Gravity Plan
Index & Cover Sheet
Component Manual Design References:
In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
Pg 1 of 4 Index & Cover Sheet
Pg 2 of 4 Plot Plan
Pg 3 of 4 Dispersal Area Cross-Section & Plan View
Pg 4 of 4 Management Plan
Attachments: Enclosures:
� POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description
Owner Name(s): �J��t �vC � 1.4, SS��� I Phone: - -
Owner Address: 1V S35�D �qt5�:.�e;�Q (��Q (,t� d���r �- Zip: S�l ��1�-
Project Address: S��m e
Govt. Lot: `J �C.,� 1/4 of S l.t,� 1/4, Section � s , T �� N-R�E Q or W
Township: (�S���,�C-� County: �� � � � �
Project Parcel ID #: ��-� �3 I �J� 33� ��.
Designer Information
Designer Name: ��4 � ' l �l�I�. Un Phone: �l S -a�� - �.��/�
DesignerAddress: �jp �j- � ��rx�l�5t>� 12GQ (,(f i�-'�e� Zip: S�l��
E-mail: c�o��r�tF`�?1c��1",�.Cp/f'( .�� . .,� ,,
License Number: p�r����C�
Remarks:
.
Signature: � Date: ___�- 1�-aa
Original sig a re required on ch submitted copy.
CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE.
� SOIL EVALUATION o sca�e:4'0 40' � 80 � SYSTEM PAGE 2 OF
SITE MAP PLOT PLAN
PROJECT NAME: oesicN F�ow: �C-l.) cao
ia'
K�.�Q�� II Attach design flow calculations tor commercial plans.
aaodEc7 noDReSS ����J'� ��`fhL'i� ��X Pipe Matenal/ASTM Standard(Tables 384.30.3 8 3843a5)
�ol.�7b FT N sa��ary��, �l" � u�
BM Symbol:-� BM Elevatlon' ��) Force Main: /
BM Descnption: � �� K/���
mmcaie oonn� IMPORTANT:
Slope Grodlent(%) .--� yy���mbol(rf applit'able): Q drawing an Show ground elevaiion con[ours at suitable intervals.
or iesied n�ea�. oo me aoo�oaaue r�.
C-7"'�
S�e''�
e
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I � � yC'
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S3s5� N
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Septic Tank(s)Manufacturer:
IN-GROUND GRAVITY DISPERSAL AREA 5��, pre �s-�
Uniform Elevation Trenches with EZ1203HP Bundles SepticTank(s)Vdume(s)
3-ft Trench (down-sizing credit) �(,��
c)w gal gal gal gal
���EfFluent filter Manufacturer
I min.12' Eftluent Filter Model#: \�'� /� `- Z7
Geote�ctile I (ry0ical)
Cover
SOILCOVER TYPICAL TRENCH
72•
min.trench ; . CROSS SECTION VIEW
depM
�yP��i� L — — ,-��. . :.; (No Scale) OBSERVATION PIPE DETAIL
. �e'`� Moswie7
System Elevation�.�3.�ft. •� '� � , s���-rypao� •
Slip Cap(loasel ��':+' Finished Gratle
(rypicaq Provide minimum 3 ft �mm�naa a s�a�a�
separation between trenches. a•e avc P�,� roosoil Cover
Topofpipatotartninale (mia'11ooQ
at or abova finis�etl gatle
(4)1/4"4l "X6"$bLs
TYPI CAL TRENCH (Show location of inlet/outlet pipe connection on plan view.) � ePan
PLAN VIEW A��ho��9oa��� �������,p�
4��!M ObSBNd�IOO plpB 9hd11 bB I�6�BIIBE $udace
(No Scale) x' atjunclionbelweeniwounib. / ft
Perforated Lateral observati«,Pipe —�
— (typical) (�va���) (Hw�O
� - - - - - - - - - - �� - - - - - - - - - - - - - - - �--`=� �v
______ ______= =--=_
I "_ __"___ _______= I A = 3.0 ft D
� - - - - - - - - - - - - - - - �s— - - - - - - - - - - - - - - - - - - - � cn�P���> G�
� `.� m
� B = � ft �i (a
(�vp��0
INSTALL PER TRENCH: EZ120YP B�ndle �
2 �
� 10-ft bundles @ 50 ft� EISA/unit= �-7� ft� (mtd by Infiltrator Systems,Inc.)
�_ Install pursuant to manufactureYs instructions.
+ � 5-ft bundles @ 25 fl' EISA/unit= ft�
= Proposed HSA per trench= 3� ft� Required Inf Itration Area= � ft' Distribution Method:
x �_ trenches = Proposed Total EISA = �Ub ft' �Ku� �"�!
T-
PAGE40F4
In-ground Gravity Management Plan
IMPORTANT:
The owner of this in-ground 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= �U� gpd; BODS <_ 220 mgL''; TSS <_ 150 mgL''; FOG 5 30 mgL''
Inspection 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 priorto 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 Sentic and dose tankls)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 (7/3)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 reports 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: IJ�n �"�%l�1��� �' S"ViIS �y�G `�L Phone: �IS'oZG��':�`SLIa
Localgovemmentunit: S4kl'�E'�^�D4���C ��/��t�`+ Phone: 7�S�3�(— ;7��i�
Local government unit address: ���I� l i �li�n SZ�. 5��� �G/ 174��'� ZIP: s�(�1�
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1),Wisc. Admin.
Code. Repair or replacement of failed or malfunctioning components shali 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.
Contingencv 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 shall be abandoned in accordance with SPS 383.33,Wisc. Admin. Code.
�""'"—T�"�^%.� PRIVATE ONSITE WASTE TREATMENT co�nty
,�:�- ,,;
�z�,
�
SYSTEMS Saw er
�_� �$ S ���;
��°,, � 1�.� ( ) Y
\„� �;j` POWTS
�,.�,F,___ �
�'-5"""''''' INSPECTION REPORT sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �� � �6�
Personal infonnation you provide may be used for secondary purposes[Pdvacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
��hw�C� v�1 U,SS 2Ll � �� �pwc� '--
Insp BM Elev: BM Description: Parcel Tax No:
�.�' � b .,,�.�, oao- 63 - ��=330�.
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic gOp Benchmark �po,� �
Dosing
Aeration Bldg. Sewer �`,-�3'
Holding St/Ht Inlet 9�; �3 '
TANK SETBACK INFORMATION St/Ht outlet �'y;�..$ '
TANK TO PIL WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic �.Z ` �-�S� (b� �--�,� � NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. c� ,g 3 �
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infiltrative �
Surface q 3��
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFOR ATION
DIMENSIONS W � L � #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav Conv ❑ Aggregate
INFORMATION P/L Bldg Well Waters � IGP o Chamber
❑ AG .d� EZFIow Model Number:
CELL TO -}-1 p� �_ .F-�'� ❑ Mound � Other
— ___ ---__-- - -- -- _-- — ---
DISTRIBUTION SYSTEM X Pressure Systems Only
-- -— - ----
Header 1 Manifold Distribution Pipe(s) 'rX Hole Size X Hole Observation Pipes
Length Dia Length Dia Spac I Spacing ❑Yes ❑ No �
--- -
-- - --
SOIL COVER
__ _- — - -----�— --- — ---- -
Depth Over Depth Over I Depth of Seeded I Sodded Mulched
Cell Center Cell Edges j Topsoii_____ _ ❑Yes ❑ No ❑Yes 0 No ,
COMMENTS: (Include code discrepancies, persons present, etc.)
������,( �bll� (a-�
-- r-- _
Plan revision required?❑Yes❑ No � � � �--����� 6 1 �
3 ° � --- G�- � I;�
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AO�ITIONAL C�MMENTS AN� SKETCH
SANITARY PERMIT NIJMBEA: �� —�6v�_
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