HomeMy WebLinkAbout022-738-14-5218-SAN-2023-188 �r�=-�
�"-�;� Indus[ry Servfces Division I County
'�� 4E2?Madison Yards Way S[L,I.J �� ,�.
j�::��,�f' � = � Madison,Wi 53705 Sanitary Permit N nber(co be niled in by� Z
�' � S %- P.O.Box 7302
�����i"� Madison,WI53707 ip s���C1 �J
_— v-i
Sanital�pet.mlt AppilCatl�n State Tmnsaccion Number 1
In accordance w�ith SPS 3R3.21(2),Wis,Adm.Code,submission of[his foim ro[he appropnate vo��emmental unit �
is rcquircd pnor to oFtaining a sanitary permii.'.Votc:.4pplication forms for stam-owncd POWTS are submittcd co P�oject Address(if differen[than maiting a� �
the Departmenc of�Safery and ProfessionaJ Services.Personal informa[ion you pro��ide may be used for secondary
purposes in azcordance wiN the Pnvacy Law,s.15.04�1)(m),StaU. r I
I.Applicationlnforma[ion-PleasePrintAlllnformafion pq I'ccVor.K �--Y�
Property Owncr's Yamc I Parccl a
��rbcr� ����LTos(,� OLZ-738 -�4-S21Q�
Property Owmer's Mailing Address Propercy Location
RBS`t w L a.,� R-` '����Z
Ciry,State Zip Code Phone Number n1 I`
� 1,t�Ce,1.0 W� 54��j I��S OJO' b7qZ —G'•��Sectian (T
II.Type of Building(check all that apply) Loi=� T�✓� N R ��
Eo W
�lor?FzmilyDwelline-NumberoBedmams 3 i SubdivisionName—
Block n
�ubliNCommer<ial-Dcscr,be L'se
�— I�Ciry of
❑S[areOwned-DescribcUse CS:NVumber � illageof
2.31111 6381 mra�mor 2�:ssov�
IIi.Type of POWTS Permit:(Check either"Nee"ar"ReplacemenP'and other applicable on line A. Check one box on Iine B.Complete line C i
a licable.
A� �ew System �eplacement Sysrem �[her Ylodifica[ion[o F.xistin�Syscem(explain) ❑Additional Pretreatmrn�Unie(explain)
�.���
B' ❑Holding Tank In-Ground I�At-Gmde �❑Mound I Individual Sire Design OtherType(expiain)
(conventionalJ �
C� ❑Rrnewai Bef'ore �Revision .hange of Plumber ❑I"ransfer�o New Owner 'st Previous Pecmit Vumber and Date Lcsued
E<pirntion --
IV.DispersaVTreatment Area and Tank Informa4on:
Design Flow(gpd) Desio Soii Applicaeion Ram(gpd'stj Dlspersal Area Required(sf) Uispersal Area Proposed(s� System Elevation �
4So , 6�f3 �r0 �ri.zs
Capacity in Total k of Manufacturcr
Tank Information Gallons Gallons � Unics V u _
�cwTank.c ExietinyTanks �c` - A
�`C% v:v � a:7
ScpncorHoldingTank 1oDO — �DO(j � �,�f2�Se�
Dosing Chambcr i � �
V.Responsibility Statement-I,the undersigned, me responsb ity far installarion of the POWTS shown on the attached plans.
Plumber's Name(Pnn[) r Plu b r's Si�at rc . i MPMIPRS Number Businesx Phone Numbe-
S��h�'Lo �(..�-��l I Z2(oB �lS-S5$-4bl�
Plumber's Address(Stmet,Ciry.Staie.Zip Code)
VI.County/Departnent Use Only
❑Approved ❑Disapproved 7ermit Fee �Da�e iswed ��, issuin�Agen[Signature
s o0,`�o j �� ��(a 3 � ����-F�.��f�f-Er,���
❑Owncr Givcn Reason for Dcnial
Conditions of Approval�Reuons tor Disappro�at . ,� �
� � � ,_; :.: g li�)a3 p�e ie�q��`� �.:;
�=����
��������''^' �--��b-- � AUG 15 2023 �'
r:�t!' 3.10 5S -- --- -----'
l�Jr� �J — Ic�-� _ SA`1�iY"r.'.Rr.,;'. ,,.i
NiNG AGt�l:�+:"::;���...�.
\ Attach ro complete pinns for tl�e syshm an submi[[o[Ae Counh'only on peper not less than 8 V2 x 71 inthes in size ��z y y-�
SBD-6398(R.02/?2) NO R�FUND.�,AFTER
ISSUE OF��T
PAGE 1 OF 4
�n�t3��€��� �ravity Pian
Index 8� Cover Sheet
Com,,,pppon���ert Manua!Design Reierences: /�� ,�.�\
Version�SBD-�0705-P (N.01/0�, R. 1C112) � �
\
Pg 1 of 4 � '\ Index 8 Cover Sheet
Pg 2 of 4 Plot Plan
Pg 3 of 4 Dispersal Area Cross-Section & Plan View
Pg 4 of 4 Managemeni Plan
Attachments: j Enclosures:
' POWTS Application for Review
! Soil Evaluation Report 8� Site Map
Project Name / Description
l -�- MLSv�-F'cs � Tr � r5 -638 - 07Rz.
Owner Name(s): � �r �et Phone:
OwnerAddress: GBsy W L�`�"` P� �- ��`�war� Zip: 5`� 8`13
ProjectAddress: o� r0.vOr �.c (,v� n
Govt. Lot: Z I/4 of 1/4, Section I`f . ?C11�R�ZE!—�or W �
Township:
R�� ss,,,� County: SGw e v-
Project Parcel ID #: �2 Z --13 8 — I 4 — SZ��
Designer Information
DesignerName: S�a'�'�O � �-�e�l-� Phone: 1'S SSS '-�6�(0
Designer Address: �SOL � N�""� Ye� f"`�� �°"�'�4v� r�p: Syg4j
_ .. ,,. _ _ . . .,-. .
E-maiL• ��
License Number. Z Z� g a�
Remarks:
Date: � C �
Signature:
,.ngira!sl9nature req.:ireC cr zaU subm��[tetl cooy.
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5 0-�-�-. Lo-� 3 0� ��o w': �e � (�-4- 3 CS►�1 z 3� l � 1 � 63 g [
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�Seplic Tank(s)M�nufacturer:
IN-GROUND GRAVITY DISPERSAL AREA (,���5-e Y-
SepUc l ank(s)Volume(s):
Ste ed Elevation Trenches with Quick4 Standard-W Cham ers ��� gai
pp � 000
3-ft Trench (down-�iz1n9 �redit) _ ga, — ga�
� ���� � � �O Fi(luent FOter Manutar.turer.
_� -- _ o �L
-_ � �1����:- _ -
- sou_covrr� - -- _�»�n.,2° _____---�---
- —_ _ (ryplcaq Effluent F=11ter Moclel iP--��--------,--
� ---------
- r
12" �
min.lrench i
TYF'ICAL��RENCH ����''r, 1- � " ide minimu n 3 ft
(�vP�caq _.__-- -. .
---_____ , � � .,. Prov
C R OS S S E CTION VIE.W -- - � _ ,��,��r a t ion between trf�nches.
3A"—'0-----"� a
� (No Scale) �----��yn����� ,a ., ' �.. . � .
. a
------
�____.___. t_.owest Trench (as applicable)
{-lighest Trench --------------- �
�1,l.ZS�' ft; �l � ,�-�� ft; C(� '-�-S ft;
, ft; P ft
System ��ev�tions=
ObsorvaftonPipn TYPICAL"1RENC1-1
(lulck4 Standard-W ��vP����� P�AN VIEW
wl E nd Cap �gh�W Ioc�tion of inlet I outlet pipe c:onnection on plan view.) �i�Stall p�r manufacWrnr's
_— (rypicai� , �ns'«�°"°"S. (No Scale)
- -- - -- -- -
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-- — -
- - - -
- ��- - ' � � �- :i.o tc
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'_ ----_—_--� m
�3 = �.�_ fl -------------------
_------------------- - W
�--•----�—" -(�uick4 Stantlard��W Charnber
(typical) (typical) �
(mfd by IntllUalor Systems,Inc.) �
�NS'�'�(�L P�,R T(�EN�'if�: Insla�l pursuant lo manufacturers instrucUons. .P
�`� Quick4 Std-W @ 20 ft�EISAlchamber= 1-�'n ft2
6 ft2�ISAlpair= � itZ
+ 1 Pairs of end caps @ _ ____
� � �� (��3 ft` Dislribution Method:
= I'roposed EISA per trench= r...�_ ft2 I�equired Infiltration Area= --
a ����"y
x
� trenches = Proposed Total EISA = �,_� ft2 ---��G` —
�-�
�.
PAGE �-(OF y
In-ground Gravity Management Plan
IMPORTANT:
The owner of this in-ground gravity system shall be responsible fcr its perpetual operation and maintenance pursuant to
reGuirements of SPS 382-384,Wisc.Admir..Code. Pursuant to SPS 383.52(2),Wisc.Admin.Code,this system shall
be consldered a humar health hazard i`not maintained in accordance with this approved management plan.
Furthermore,all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in
accordarce with SPS 383.52(3),Wisc.Admin.Code.
Maximum Dispersal Area Operetinq Limits:
Design Flow= 4S� gpd; BODS<_220 mgL-'; TSS 5 150 mgL''; FOG<_30 mgL''
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
c age of system
o ruisance factors(i.e.odors,user complaints,etc.)
o mechanical malfunction(i.e.,pumps,valves,switches,floats,etc.)
c material fatigue(i.e_.leaks,breaks,corrosion,etc.)
o solids volume in anaerobic treatment tank(s)and any distribution appurtenance(s)(i.e.,distnbution/drop boxes;
o neglect or improper use(i.e.,exceeding design capacities,prohibited activities,etc.)
o exten?of ponding in distnbution cell prior to dosing
c dosing irreaularities-if applicable(r.e.,pump re-cycling,float switch settings,etc.)
o electrical components-if applicable(i.e.,wiring,conrections,switches,controls,timers,alarms,etc.)
o disvibution lateral or lateral onfice plugging (meascre lateral distal pressure—compare to design specification)
o surface discharge ot effluer:t or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS(or when necessary)
c Septic and dose tank(s)shali be pumped by a certified septage servicing operator licensed under s.281.48 Wis.
Stats.when the volume ot solids in the tank(s)exceeds one-third(1B)the liquid volume of the tank(s)or
as required by iocal ordinance. Disposal of contents shall be pursuant to NR?13,Wisc.Admin.Code.
o Effluent filterlsl shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufacturer's specifications. A servicir,g 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 comp�nent failure o alfunction to:
� 1 5��Q"n°„T�`� _7jS,—�^t�/(a
Nameofindividua�orcompany: rI�"" 5 Phone:
Local govemment uni?: ssw`�r �v �o"t�n� Phone: ��5-63�l—gZ
Local governmer.t unitaddress: I Ofo ID �4�h S�•#�ct '�'��Nt�22�� �I ZIP: s4��3
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 restoratior.of the POWTS may be used unless approved by the department fn
accordance with SPS 384,Wisc.Admin.Code.
Continaencv Plan
In tne event that any railed treatmer,t component of this POWTS cannot be repaired,it shail be replaced pursuant to
a plar submitted to the appropriate ager.cy 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 scils.
Svstem Abandonment
If use of;his POWTS is discontinued,it shail be abandoned in accordance with SPS 383.33,Wisa Admin.Code.