HomeMy WebLinkAbout032-540-30-5106-SAN-2023-187 „���=�., Department of Safety �°"°ty CJ�� �
,�`,�_ _ &Professional Servicea, �,,,��,�;IN��� c�ru�emq,�
`� �a ' Industry Services Division � �
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Sanitary Permit Applicarion Snte7reasectioaNumbcr P�
ln accordence with SPS 383.21(2),W is.Adm.Code,submission of this foim ro We appropriete govemmrntal tmi[ ,,
is mry"uvd qior m obmmmg a emimry pmmic Notc:AppliceGw folms for Neteowned POWiS ere submitoed m Aoject Addn.ss(if diffmart tLen ma�l'mg u
the Depanment of Sakty end Pmfestioml Servica.Personel infomution you pmvide may be used for uoondary
p o:es�n accordmcc w�th tLe Privary[.aw.s 15.04(txm).Stus. /O
I.A dcatino Intormapon-Plene Rint M Intormatlon � tp l�S�.t, G ��
p[OpE[Iy�WREt 6�`�20C P]li�/�
`1a ��ere5� �r,.i,c e o •5� • c�• 10(�
Rapecry Owncr's Mailing Address ���W��r
l31 a c`�� e�v��x,Q �.,.� --x
City,Sm[e ZipCode PhoneN�bc
1,-3oc>n� l-� s�17 "�15-57 ��`1�7 �, %�� 3 0
a.iy�,e otsuaamg(cee�au macappy) 3 ��# r O N R s w
�1 or 2 Femiiy Avelling-Ntw6a ofBedmoms ���0°N�
Block 1t �—
❑Public/Coromcicial-DexnbeUu
❑Ciry of
❑StateOwned-IkscnbeUu � (SMNumbet ❑Viliageof / 1� _
CJ`� 1 7 a 7 �4Town of IA,�n L`C.'1� _
III.Type of POWTS Permit:(C6eck eitha"New”or"Re@Lcemeot^aod oWer applkable oa Bne A C6eck oae boz on line S Compled¢tlne C
a ticsble.
A. �New SY�m ❑RePlaremrnt SY�m ❑Ot6er ModiScetion to ExistinB SYetem(exPlain) ❑Addiumel Pretrea�eN Unit IuPlain)
B' ❑Holding Tenk Io-Cmund ❑APCrtade ❑Mwod ❑Individwl Site Design ❑OWer Type(e�lein)
(conventioual)
e. ❑x�e�i se�� ❑��S�oo ❑en�,e�orr�� ❑hsosfam New Owoer '�r��r�N��a naa r�a
Espus4on
IV.Dle rsaUTreatmeot Area and Taek IePormatloe: "2 JkJ wl� 5 ,/� �
nesibm Flow(apd) nesi�sa�app�iceHan Ratqgpd/s� Uisrersa�A�a R�9�ved(s� Di�e�l Arta Proposed(s� sysoem aevariw
��S' , �J `17.d -�D `IS:lU
Cepaclry in rotal 8 of Mmufai.tmer
Tank fafo'madon Galloos Gallaat Umts �� V$ �
NewTmb Eci4mgTmb Y o „� � �m �
e.U in vi i+'.U a
SepricorNddingTa�Jc � ���c�
Dosing Chamber
V.ReapoosibiHty Shtemeot-I,t6e aede`rig�ed,asame rapou�Biry for imta9�tloo of tLe PON7S a6owa oa the attae6ed phm.
Pluy�er s Name(R'vmt) PI Si�a4ve MPIMPRS Numher Busmes Phwe Number
!'/��t�r'` .S�' ti c�c�D c�1 C� 71S�6 6�-c��Lla
Plumba's A (Strcet,City. ZR Code1
So�S`� ?�� 58 f I��e�, l� S
Vl.County/Department Use Only
�A � ❑Disappmved �t Fa Dete Issued lssumg Agent Si�nture
❑�a��R�o�� s`tc�o.�° BI�NIa� �I��H�-�-
Coodidons of A provaUReasoas for Disappmvel � N [�.��� D
N
������u�w'� '-`ai�-,_���"`��"__''.___�._ _
,-n�� _i���3 AUG 14 2023
�S� �3-06�� ��D J!� $AWYER COUNTY
�_
� ZONtNG ADMINISTRATION
em�em�..p�v�rorm�mr�..a.oemNroneco.mr�h�wa•*•arnwoe�rz=u�.memr.� 3�31'�
SBD-6398(R 03l22) NO RCFUNDS AFTER
ISSUE OF PERMIT
PAGE 1 OF 4
In-Ground Gravity Plan
Index & Cover Sheet
Componenf Manua! 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): ��.�! d- �{'e.,�, �r�Ck�-�,� Phone:l��-�_- `( ��
Owner Address: J � �o� � ���.i,vcX� �r. Ia�-�c�Qn� l�J� Zip: �t-i � oZC�
Project Address: (oc(1S�Lc� NernI �LK ���� �cX
Govt. Lot: �- 1/4 of 1/4, Section 3 C� , T_�N-R�_E Q or W �
Township: (�/ i�1��!' County: S 4 w��r ��"
Project Parcel ID #: d�:� ��l � 3C� ��D �O
Designer Information
Designer Name: �('� � ' � l� sU/� Phone:7�� -v2�� - �.�L
Designer Address: �^(� �c�r'r1 � n � �i01��Zip: ��f��Z' �o
E-mail: r,Qo��mps�n llc � %i U�� Cv✓►'� � .,� , � . . . � . � , � ,,:�„�,..
z �:
License Number: p� c�C��[�
Remarks:
q �_ rj_� �
Signature: Date:
Original sigRa re required on each ubmitted copy.
CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE.
❑ SOIL EVALUATION o sca�e: 40 4a� � $o � SYSTEM PAGE 2 OF
SITE MAP PLOT PLAN
PROJECT NAME: ��o n rid) ��� DESIGN FLOW: L� GPD
9
Attach design flow calculations for commercial plans.
PROJECT ADDRESS: IJ�I�5—� N ec�10�K }�Wtl� Pipe Material/ASTM Standard(Tables 384.30-3 8 384.30-5}
ii
N Sanitary Sewer: � / UC-
BM Symbol: -� BM ElevaUon: �C��C� FT Force Main: /
BMDescription: ���P i 'n 1�"�CrSSkX�iQ
Sio e Gradient %) / Indicate northby IMPORTANT:
P ( //� well Symbol(if applicable): 0 drawing an arro,v Show ground elevation contours at suitable intervais.
of Tested Area: on the approprite line.
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C.�t C'.r �-a, � '' �� �_
IN-GROUND GRAVITY DISPERSAL AREA Sep[icTank(s)Manufacturer
�u��c,a--E'�
Uniform Elevation Trenches with EZ1203HP Bundles SepticTank(s)Vdume(s)
3-ft Trench (down-sizing credit) '� ',l
1�S�L gal gal gal gal
Effluen Filter Manufacturer
� �_� ��S-� �,l-�.e�
Geo[eztile I min.12" Effluent Filter Model tit � L�_O
Caver I (ryPical)
SOILCOVER T TYPICAL TRENCH
m��.'�e��n1 CROSS SECTION VIEW
depih
(h,Pi�l) 1� __ �'��.:�.;;� (No Scale)
OBSERVATION PIPE DETAIL
(No Srale)
System Elevation=���SD ft. ���� s"ew-Ty°e°r F���shaacaaa
(typical)
Provideminimum3ft s"PcaPO°°sa� �mw�naaasaeaaa�
separation between trenches. a•m Pvc P�Pa _ roPsou co�a�
roa oi P�aa�o�a���a�a cm��.i roo��
a�o�aoo�a n��snaa yaaa
(4)1/4"-1{"X 6"Slots
TYPICAL TRENCH �Show location of iniet/outlet pipe connection on plan view.) c� aPan
PLAN VIEW n��non�eo�� i ruo-a�b„
4��� oesaNaro�Piaa snan�i�smiiea sueace
(No Scale) a�;����o�ba�,ea��wo����.
Perforated Lateral ObservationPipe �ft
------- �tYPical) (�vaicap Rvaicap
r------ -----��----------------�� -�
� ___°'_ ------ __ ___ __:___= I A—3.0 ft D
- �_-___ ________ —
�----------------�f-- -----� cty���� G�
------- rn
'r B= �c� n =1 w
(rypical)
INSTALL PER TRENCH: EZ120YP B�ndle �
� 10-ft bundles @ 50 ft�EISA/unit= '�ft' (mfd by Infiltraror Systems,Inc.)
�
_�. Install pursuant to manufacturers instructions.
+ — 5-ft bundles @ 25 ft�EISA/unit= ft�
=Proposed EISA per trench=_�fl� Required Infiltration Area=�ft� Distribution Method:
x _�trenches=Proposed Total EISA= �f�t n' ���v'c�{
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
accorda�ce with SPS 383.52 (3),Wisc.Admin. Code.
Maximum Dispersal Area Operatinq Limits:
Design Flow= L�S� gpd; BODS 5 220 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 boxc�s)
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 vJis.
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(sl 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: ��n d' .wlLS �� LZC phone: ��S'02�6 "oZCSL)c�_
Local government unit: ��'c IiNC�f C.D�.I�`��/ �D/�!R`� Phone: 7/$� (0 3�J' �o���
Local govemment unit address: �(��0�(7 rn�i'n SZ� Ski'�'L' "[� �``}�4�.✓l ZIP: S�f�i���
Any defective part of this system shall be repaired, repiaced, 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.
Continqencv 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 shail be abandoned in accordance with SPS 383.33,Wisc. Admin. Code.
'"�` ``%;;. PRIVATE ONSITE WASTE TREATMENT county
_,,� ,,
,
$ � SYSTEMS Sawyer
� � ps ' ( POWTS)
`_ :�
��°'"'" � �� INSPECTION REPORT sa�itary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION 23_ �'g 7
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
�y ��'���sa 9�k� w��..�-
Insp BM Elev: BM Description: Parcel Tax No:
L°°�D` 5.�►� ih b�o�� o3�-�yo-3o -�'/o(�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �� Benchmark �op,o�
Dosing
Aeration Bldg. Sewer � o�,o�.
Holding St/Ht Inlet ��.� '
TANKSETBACK INFORMATION St/HtOutlet ioo.3 '
TANK TO P/L WELL BLDG vENrTo ROAD Dt Inlet
AIRINTAKE
Septic ±��` 3$` �� �3 NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. 96.(S�
Holding Dist. Pipe
PUMP I SIPHON INFORMATION infiltrative �,��
Surface
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFO MATION
DIMENSIONS �N L p p` 6p` #of Cells3 Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate
INFORMATION P/L Bldg Well Waters � IGP ❑ Chamber Model Number:
❑ AG �C EZFIow
CELL TO fU �r- ❑ Mound � Other
-------- - _�� __ '�Sa .}-l_ab _
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 Mulched
Cell Center Cell Edges II Topsoil ___ 0 Yes ❑ No l ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
���l� Il �� -.2� (�a�3
l
_ , �
Plan revision required?❑ Yes ❑ No Id3 � �3 �2Y _ J�� - --- J ��.'b �� �
Use other side for atlditional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AODITIONAL COMMENTS AN� SKETCH
SANITAAY PERMIT NIJMBER ____�,�=_�� _
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