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HomeMy WebLinkAbout032-539-03-5313-SAN-2023-166 • ' Indus Scrvices Division County 4822 Madison Yards Way �W y e � y ; �t Madison,WI 53705 Sanitary Permit Number(to be filled in by( Z �s P.o.Box 7162 Madison,WI 53707-7162 (.[� S( U� G � :.� Sanitary Permit Application State Transaction Number � In accordance with SPS 38321(2),Wis.Adm.Code,submission ofthis form to the appropriate govemmental unit �— o� is required prior to obtaining a sanitary permi[.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing ai � the Department of Safery and Professional Services.Personal infortnation you provide may be used for secondary purposes in accordance with the Privacy Law,s. 15A4(I xm),Stats. ����� �/64r�`�� �� l.Application Information-Please Print All Information T Property(hvner's Name Parcel# � C�e�,`Ce_ L��i/•` 032 -5�3�'-o.3 --5.�/� Property Owner's Mailing Address Property Location C�y2 !.�• ��^%��.�`� �2ao' �a,�.Lot City,Siate Zip Code Phone Number �e�G>(/'�il�^y (,.C�� � ?�cj�z '/a, '/a, Section �� J J II.Type of Building(c6eck a0 that apply) Lot# �( T N R S E W �I 1 or 2 Family Dwelling-Number ot Bedrooms � Subdivision Name Block# ❑Public/Commercial-Describe Use � ❑City of ❑State(?wned-Describe Use CSM Number ❑Village of 3a/3o�/ �?�02°� i"Townof (�:.1� ��- III.Type of POWTS Permit:(Check either"New"or"ReplacemenY'and other appGcable on line A. Check one box on line B.Complete line C if a licable.) A' �New System ❑ Replacement System ❑ Other Modification to Existing System(explain) ❑ Additional Pretreatrnent Unit(explain) B' ❑ Holding Tank �In-Ground ❑ At-Grade ❑ Mound ❑ Individual Site Design ype( p ) ❑ Other T ex lain (conventional) �'• ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner �st Previous Permit Number and Date Issued Expiration IV.DispersaUTreatmeet Area and Tank Information: Design Flow(gpd) Design Soil Application Rate(gpd/sfj Dispersal Area Required(s� Dispersal Area Proposed(sfl System Elevatio �3b o . '7 �•� � Sov . S (a/.p � Capacity in Total #of Manufacturer :3 Tank Information Gallons Gallons Units � U U �, � � New Tanks Existing Tanks y c � " � � � � 0 a. U � � c� u. C7 p.. GfJ''►� Septic or Holding Tank /�L.,G, CO OLy � �U.F e� t 'j`'�y, l —�" ' Dosing Chamber 0 V.Responsibility Statement- I,the andersigoed,assame responsibility for installAtion of the POW TS o 0o the attached plaes. Plumber's Name(Print) Plumber's Signature MP PRS Number Business Phone Number Vn;Ke V►'�o�,� �.me.� • �i��� a�2 si� �7,s�-o�G(�-3o�r� Plumber's Address(Stree Ciry,S te,Zip Code) `'l3Yd �t1 !r-�k� t,�J;.�t�cv /� I�����v� (� �f'��G VI.Coun /Department Use Oniy �Ap o ❑Disapproved �ermit Fee Date Issued Issuing Agent Signature . ❑Owner Given Reason for Denial Y�,,�° 1 � � � ��� ��V 1 i��-� }-�a- Conditions of Approval/Reasons for Disapproval � 0� ��31 a� ��`--`�%�����1_=��� ,j I � ��� �a�� .�_m�. _ ; , � �� G -�k .. �hk# ���s , �-�' JUL Z 0 2023 ` yj Cs� �� - �-o�� �tt�nt# aN�3 -- —__.._� C :i<:V'�/Y�r; r.C�i��,fTY ZUNiNG ADMiNlSTRATION Attach to complete plans for the system aod submR to the County only on paper not less t6an 8 Irz a 1 I inches in size J.��S y NO REFUNDa AFTER ISSUE OF PE�sM1T 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 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 Evaluafion Report 8�Site Map _ __ _______ t —_ -- -- _ -- Project Name/Description Owner Name(s):_�j,./(� ('�ev,["� L�i�S Phone: - - Owner Address:_�/Z l.�J ,Q:��iG � L�t��G�.� Zip: ,S,�D/ ProjeCt Address: (09aloN dtJPS��?'+v6L�' /1� �i �,� �,.>T Sy�9G Govt.Lot: 1/4 of 1/4,Section b3 ,T��N-R $ E❑or W� Township: LiJi'.��f✓ County: S�w S/�(i Project Parcel ID#: D 3Z -$�f-0 3 -S"-.�i � Designer Information Designer Name: �Vj; AC yl'1o��"� ihc�.� Phone:7�5-��G- 3c�/o Designer Address: �-I3Nv,v L e�, )1.��[v d�rQ G✓,-c ,�Zip: ��f'6 E-mail: W� License Number:����p ��J Remarks �� �� v r.J� D JUL 2 8 2023 SAWYER COUNTY ZONtNG ADMINISTRATION Signature: `,���''-r2 Date: ��-•:?����3 Origfnal signature uked on esrh su6mitted coPY� �_ � � , �o �- �' 1� v� � p_�,���r. : L� -1 � �r K- � G�e v'i.�� L- GL Gt-� � S�w�ev- � - � � � n.Te ti- 7'`�'.� b'�Z. w Q �,�c. R- � �� � ; D�-- S 3 9 - 0 3 _ S 3 t 3 C�d��- b� �� , � �, s 30 �z- .� 0 3 T 3� t� tz os w Jr� C�i : G 1 �-i� I�/ V�l� { +�Yr�h- • "� �� S.. � � s . 1 30/3�� � � �ZT \ "`_�r��. [�,u� �E. " f ± 6�� � � � ` , � � \ s�(� � � �a Na'�-•�DO � . � �.- rtC6� �a-� ^'40 �aba�/l Ov►.�� � d ��� p �e zo so �l0 �O �� � sr��ao , Tm P o-F we c1 � �d �l g [. IaS.4Q � . L � Z. 1 b�f.� 3� ge� �oo �� 3�. it1 Lf_9�' � �oD' Is�� Sf, �Z s�. �5� S�s�'� etQ�_ fbl.z5- � y� tpb`� ibt.s ' � � c��e Fs-�c . 5 .T i h '��t�E` . J ��L���. a'' tz -�Io �D , � - �� sm� � .Ff- � + . �5 � � E��° s� �l�v. � a�y� --___ .—______� _ _ 6��6 � .�—� �'v Co ��Sa Wes�' ��� l'e`r �- � IN-GROUND DOSED-GRAVITY DISPERSAL AREA Uniform Elevation Trenches with EZ1203HP Bundles 3-ft Trench (down-sizing credit) 'Y 'Y � ,�_ � � m��.�r Geoteatile � �ryP�,� TYPICAL TRENCH Covar SOIL COVER CROSS SECTION VIEW +z� (No Scale) min.trencn OBSERVATION PIPE DETAIL tlepth (No Sm�e) (Noiceq L —r — , -��e s�,.w-ryoaor Fi��.nsaor.a / Sua cac M�ae) �muicnae a aeeaaa i System Elevatbn=/DI,�{t. � , a�evvca�c. rooa�eco�e� (ryplcaq Provide minimum 3 ft a�oPa�i�ia aa""" - t""",�°°9 separation between trenches. 9��� (d)1/4'-1/Z"%o'Sbk ¢�$0 sPerl TYPI CAL TRENCH (Show location of inlet/outlet pipe conneclion on plan view.) a,�u�an�a oa,� i�rn�..e.o� sunea PLAN VIEW (No Scale) 4„� onArvm����nr��snaii oe��m,r e Perforated Lateral a�""���b��W�������� ft Observation Pipe (�ypical) (tYPica1) (Np��l J �- ---��-------------- - � _:_:____::_:_ :--__ __ ___ :_;:__: :_______ � A—3.0 ft D L------- ---�f-------- ---- — � (�YWcal) � r B= so ft —�.; m taa���> w INSTALL PER TRENCH: EZ1203H Bundle Q �$Z� (typical) —n S_�, 10-ft bundles @ 5011�EISA/unit= S��' ft' (mta by InfilVator Systems,inc.) � Instell pursuant to manufecturels insWctims. + "— 5-ft bundles�25 ft EISA/unit= — ft' =Proposed EISA per trench= ��O ft' Required Infiltration Area= y��ft' Distribution Method: x �- trenches=Proposed Total EISA= So o ft' _TlT Gyv k�i RESET PAGE 4 OF 5 GRAVITY-DOSED SEPTIC / PUMP TANK SPECIFICATIONS (No Scale} a•ta van►�pe »a a r�, Buildng Eleclrical mu�com�y with 1 T'M'sn. or 2.0 ft above SPS 316 and NEC 300 Established Flood 5evation Weatherproof Extend manho}e riser as necessary. (�YP��) .iwxKia�Box A�� Appmved Lodcing Manhole IMPORTANff: Ve"�C1"'R w+m wami�g�abel,v� Anchor tank(s) as necessary t �ty��� pu�suant to SPS 383_43(8)(g) �C�"d"� a•afir,. o.z.o n acove Established Flood Elevafion (�YR���) �Airtighl Seal �� Finished Grade � . Quidc Discannect 18"Min CAPACITIES @ �5..1. 3 ga�n : : � �� . . • «� _ -- a , Z Depth {in) Votume (ga!} A �� �-j C * • + � 7 � • �-I e � W�p . �Approved Jdrtts with Nde Approved Pipe 3 fl onto B 2.0 3Q, 1.�,/ �� �j`f� A Soh�round P' tc] ' � � � � .q " , Lp� . . � •�-�---- � �AL�m o � r S2. 3 � � :0_�. �-(� f (cI �mP 1 PUMP-0FF *Pump Tank Liquid Levei =.����in � �—oft : ELEVATIOfd = ����s ft �� Force Main Diameter = d� in D ��retc� iNSiDE BOTTOM �� / B'°� ELEVATION = D• S fit . : _ Force Main Length � ��ft 3'Appr°ved Bedding Material Beneath Ta�c l"l.Q 3 Force Main Void Volume = ���9a1 � � [C) Totai Dose Vo(ume TDV = . 5 gal/dose �'. c � ��� C� � 7.93 9-�� , ( <0.2X design flow+ force main void volume) Vertical Lift = l• S ft PUMP TANK: SEPTIC TANK(S): Volume =����gal Total Valume = /Q p O gal � Manufacturer. /fi�v �-tC� '�'�'!� �� Manufacturer(s�: �v�.�����/t �.�1.(C Pump Manufacturer: � � %,�S" tnstall approved effluent filter at the septic tank outlet Pump Model: A� y j (SeeattacneC ;xfmpcurve.) immediately upstream of the pump tank intet. ControlslAlarm Manufacturer: S �C R�fl,Mb„ F�lter Manufacturer. D✓'P � � o ControlslAlarm Model: '� 'y L� Filter Moriel: lt�U � ��'�7�,c�� �PY PAGE�OF� In-ground Dosed-Gravity Management Plan s ,� IMPORTANT: The owner of this in-ground dosed-gravity system shall be responsible for its perpetual operaGon 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'rf not maintained in accordance with this approved management plan. Furthermore,all inspection and maintenance activities shall be performed by a regisMred POYVTS Maintainer in accordance with SPS 383.52(3),Wisc.Admin.Code. Maximum Disaersai Area Oceratina Limits: Design Flow= 3!��_ gpd; BODS 5 220 mgL"'; TSS 5150 mgL''; FOG 5 30 mgL"' insoection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance fadors(i.e.odors,user complaints,etc.) o mechanical malfuncGon(i.e.,pumps,v�ves,switches,floats,etc.) o material fatigue(i.e.,leaks,breaks,cortosion,etc.) o solids vdume in anaerobic treatrnent tank(s)and any distribution appixtenance(s)(i.e.,distribution/drop boxes) o negiect or improper use(i.e.,exceeding design capacities,prohibited activities,etc.) o extent of ponding in disUjbution cell prior to dosing o dosing irregularities-'rf applicable(i.e.,pump re-cycling,float switch settings,etc.) o eleclripl components-'rf applicable(i.e.,wiring,connections,switches,conlrols,timers,alarms,etc.) o distributlon lateral or lateral orifice plugging (measure lateral distal pressure-compare to design specification) o surtace discharge oF effluent w sewage badc-up into structure served AAaintenance Checklist MAINTAIN EVERY 3 YEARS(or when necessary) o Seotic 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 in fhe tank(s)exceeds one-thlyd(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 ftlter(sl shall be inspected every 3 years and shall be deaned when necessary to remove any accumula[ed solids according to manufacturers specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local govemment unit in accordance with SPS 383.55 Wisc.Admin.Code. Report any component failure or maffunction to: Name of individual or company 11�1on�-�r5 �1 J M�b :� ___phone: ��S-a�(��r•-3�`/D Local govemment unit: saw�t c� �p' c�rt�y �u c�-v� phone: �i 5-fo 3 y-�ot 3 S' � �--- Local govemment unit address: /bG/b //Nv'r� Sf. [Ne�yuxi•,.� Cd t Z�p: 5¢Sjy'3 --v- Any defective part of this system shali be repaired,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,�sc.Admin.Code. Continqencv Plan In the eve�t that any faileed treatment compone�t of this POWTS cannot be repaired,it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A faded in-ground dispersal component may be abandoned and replaced by a code-complying dispersal component in a prc determined area of suitabie soils. System Abandonment If use of this POWTS is discontinued,it shall be ebandoned in accordance wkh SPS 383.33,Wisc.Admin.Code. �'Ytlt.'7�S: 1:fLMff) 1557HiM6t2YAtiMLLYN �m�i}^�.iJ"�ii�� � Ill( C� � i!> l7+ • � a�n,n a .{I .;�. -�e) . s:i: £z �:,, �tll 3t9i19U0� .�.._ :� ..:r> � 1�, .i ii r �S ` '�3 �. :J uL91UD'J': � :lYLI ��l!'J r ...+ ��n , _,,.! ,�� i1n���nH � Y � dk r�_` ��3b_� P�Ee[ aSty 1.��CL�Bd � c h N q Z r G: �1 c i .. F y.�..y � �Vf ,. y '! '1 �a � � � .� a �� n :: h_ 7� —1c.__--' �.; �� w^ .i . ;, . . � c�`�n :- �� � , i `�_ --�-r � ocu - � i •rT-'r __'�` �, �� �a n l� � � ; Q.-, :�� ► u -. 7 �� L ` � "r- � _ � � Q i ``s � t� ;' ,�- _ _-�' ------ t y � i 4- �a .; 'a � -..�.. q=` '.^ , � � ., - t.: Q� n� ,Y 7 �. g�1� u:.� � {W ' Cr j , � N + ^ � � .� � i � 4,�.�. 4 ' O . . i � ,� i W� .. � i L m� ^. F �y�j : 1 � u ( � Q'u 2 J�.l � !) � . � � � i � �` ~� V �� � 2` � G-� • :.�{a G IJ .i`-' y � `'': , ; ffj� P y ' z ' 1e ; 3 i.,'�i! n+ .9 � . 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'{ � W , � " _' s ` �� `�' � � ��$: � � � �� ' 1 ..�1.-.. . �1 �3C���y 2i�� '(, .. y � y, . �p a�C� � e�' � .r� _ . � . :�b �� \ �,1 '�t, ��� X �ks .�C ,;�� f`J `� "�``E`�; PRIVATE ONSITE WASTE TREATMENT County �=���o$ ��; SYSTEMS �'� �S �� ( POWTS) S aWyer \�H ��_��/�� '' "�` INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �.3 _ Ib�O Personal infonnatio�you provide may be used for secondary purposes[Privacy Law,s. 15.04(l)(m)] Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#: i<�(. ��'i� 1•���� In��,��2� Insp BM Elev: BM Description: Parcei Tax No: ���� � T� a� w� I o3z— S�9-03 -S3 � TANK INFORMATIO ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic �� � (p�so Benchmark OO�a� Dosing .- �,,,��-� o,o Aeration Bldg. Sewer q S'q � . Holding St/Ht Inlet 3,Q � TANK SETBACK INFORMATION St/Ht Outlet � �,g ' TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet AIR INTAKE septic ��� � ' 1� �� NA �tBottom 4��3 ' Dosing �• r � r NA Installation Contour Aeration NA Header l Man. /p l 9s-� Holding Dist. Pipe PUMP 151PHON INFORMATION Infiltrative r Surface L�_d Manufacturer Demand Final Grade Model Number rl�r�{ GPM �i L �}% t o�.6 � TDH Lift Friction Loss Sys Head TDH Ft Forcemain L Dia Dist.To Well DISPERSAL CELL INFOR ATION DIMENSIONS �N 3 L � #of Celis Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav � Conv ❑ Aggregate INFORMATION P/L Bldg Well Waters o GP ❑ Chamber Model Number: � EZFIow CELLTO �}-S .�-�op� �-�p�' �� ❑ Mound ❑ Other ------- . .. DISTRIBUTION SYSTEM X Pressure Systems Only Header I Manifold Distribution Pipe(s) ' X Hole Size X Hole Observation Pipes I Length Dia Length Dia Spac ' � Spacing ❑ Yes ❑ No � ---- — ----- -- ----- -----' —� SOIL COVER De th Over De th Over De th of Seeded/Sodded Mulched P P P 1 Cell Center Cell Edges Topsoil ❑ Yes ❑ No ❑Yes ❑ No � COMMENTS: (Include code discrepancies, persons present, etc.) �y►.,s���{ �13, ��� Pian revision required?❑Yes ❑ No � 3 �� � �� � I G�� � 1� ___-J � �� Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AOOITIONAL COMMENTS AND SKETCH SANITAAY PERMIT NUMBER:___ Z���_____ 1 ��a ��d' P�`�'' << P ` ,� o � ��? ? ` � , Og� _ , . _. . _ �� �- 1�� .___.--j � : � � 0 � �Y t kS� � � �� ' � � �K ��°°��° O wl�b g• �� �C ��� � M° x` � .4� n � � � � , �� �� t� a26� �-� N ��.'`� � w� SCALE i"= Y