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HomeMy WebLinkAbout012-740-24-4306-SAN-2023-234 ' Department of Safety c°°°`Y v`' • & Professional Services, `S�'�'`' � � . t Sanitary Permit Number(to be filled in by � �: �: Industry Services Division C�S ► � �� � State Transaction Number � Sanitary Permit Application ' In accordance with SPS 383.21(2),W'is.Adm.Code,submission of this Yorm to the appropriate governmental unit �— � I is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing W the Department of Safety and Professional Services.Personal infonuation you provide may be used for secondary � purposes in accordance with the Privacy Law,s. 15.0411)(m),Stats. �� �� � �������� ��-, I.Application Information-Please Print All Information Propeny Owner's Name Parcel# �i�cc-r l�s K . �u; �t z - 7�a -z�{ -�f 3a� PropeRy Owner's Mailing Address Property Location 8(� D d�n � . ��--, City,State Zip Code Phone Number c�� S� l��t'L�Q 1 L �0��3�{� �30-8�6 �-�t3v7 s�' '/<, S� ';, Section Z� _ II.Type of Building(check all that apply) 3 Lot t� T N R � W� �I or 2 Family Dwelling-Number ofBedrooms Subdivision Name �� Block# ❑Public/Commercial-Describe Use �� ❑City of ❑State Owned-Describe Use CSM Number ❑Village of �Town of �'U-r'L'tC-V QL Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable 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 Pretreatment Unit(explain) B. ❑ Holding Tank � In-Ground�(:,S�O) ❑ At-Grade ❑ Mound ❑ [ndi�idual Site Design ❑ Other Type(cxplain) (conventional) C• ❑ Renewal Before ❑ Re��ision ❑ Change of Plumber ❑ Transfer to New�Owner List Previous Permit Number and Date Issued Expiration (�V� K. � IV.DispersaUTreatment Area and Tank Information: ' Design Flow(gpd) Design Soil Application Rate(gpdi�s� Dispersal Area Required(s� Dispersal Area Proposed(s� Systcm Elevation �t�� �� s 9� 9a� �o y, s ` Capacity in Total #of Manufacturer � Tank Information Gallons Gallons Units � � ^ "$ � �c3 U .� � Nc���Tank> Lsistin�_Tuuks L � u y � c3 a"�s C. U c%7 "v, v] LJ. :7 G. Septic otldelding Tank �O�Q � �1 ���5�� �,�„ n wo Dosing Chamber / � /_,�,^ �Nl� lD �OW V.Responsibility Statement- [,the undersigned,assume responsibilitv installa'on of the POWTS shown on the attached plans. Plumber's Vame(Print) Plumber's Sign�4�ze��-�j �, �;,�� . MP/�9i'R8 Number Business Phone Number ��.s�'' .� � �;,:.�:u•::'"- (0 7S�..5� �7 l S=��1 g-3 j�S� �'asc,� �Cu��t r Plumber's Address(Street,City,State,Zip Code) �C . �G�:. G7� �Ct�OI-E 1.c1-L S��u VI.C un y/Department Use On1y �A �d ❑Disappro�ed Permit Fee Date Issued Issuing Agent Signature ��'✓ p_Owner Given Reason for Denial � ��� �1 �(`i ��� ����������� Conditions f A proval/Reasons for Disapproval ; 1 � � � ��, 2 � ��N � ��r� r� { d/ i� ' �� �(��.L`��� —�—._. �R� c J ��-`j�r Y �����r _�.._ ii �� i o�� [� SEP 15 Zp �'�' _:�►!�#_ .� 23 C`J��3 — � � 3 f,�,�:�� 3 v1�5 _ S�WYER CO�.��3�-�. t�Nt;��AQMIlvlS'i RHl-ION Attach b complete plans(or the s�stem nd submit[o lhe County only on paper not less than 8 v2 x i l inches in size , S�j� 1�✓D�u�R � fJ��LFUN�S p�TER SBD-6398(R.03/22) ���E��f31�1T �� 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 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 Evaluation Report&Site Map Project Name/Description Owner Name(s):U�ar1e5 (� .�Lcu.�nUa r�.Y+ Nu s� Phone: �3� -�;�C�- 43C 7 Owner Address: SI'7 Dv+�c�ev� `�. C��n�-�Ici,SL Zip: ��13`-f ProjectAddress: 8(31N Wcz�c(Iu,�d Dr. l-�tcc,cuarc��G��T s�l84�3 Govt.Lot: SE 1/4 of�_ 1/4,Section a'{ ,T�N-R '7 E❑or W� Township: � i.�s��e;� County: SQ���C�.� Project Parcel ID#: pl2-��f-D-z'-4'- '-E30�C Designer Information Designer Name: JCLSo�� KU-e{'�e-� Phone: ?�S- 79�-�',�s3� DesignerAddress: ��G, g� (o� (�q(o���_ Zip: S"�{�Z/ E-mail: i'iw��v n:��rusa5.c.om License Number. (o�_C 7s/ Remarks: �,: �f/.�—s-�`�'._" Signature: y`�'-✓ Date: 9�/i z3 Original gnature required on each submitted copy. Ow �ew � �e �� ' �q� .�DYhPSO✓� SQ�' �-C'U� 54w�Qt-- ��� �!j►'1��tr 1�'v � S l� (�c�d�c� 5-1-. �I tJ �� o tZ- 1yo, 2�{-- �-�'3�tP G e+�,{� Q-� z � 6 0 �3�{ sw�s�� s E/s� � z4 � �i a �J 2 0 ? �v (� 30 - s��(a - q 3v `7 ���i y � ' w00 ��4h.� �r C� l..C. —�' � 813� �j � 83 �3� 3 ` x �o ' s�e ���_ �� � GPt_LS W� �' z ���il<. p lo Zp 30 yp ��� U-Nl'�) � a �, �oo� ga�.s.� sl�.� (3� Q S t . � o� .s6 z. ID6 - `�� 81 � 3- la6 . � � ? .S Sa< <s s�s+• --� �l eJ • f D �t. S £� S.T- �•.i �1-I ` _'{ � �CJ I.' �i 1 �9 . p yC. � l�t� �' p��p�s� �,� �►d = q�` , ,.� w 0 � • �n��o � w�`1 g4� 3 6�. Pr�pos�c,� i.�;ie s�r� i000 ��bo w j eo«�. O�r�co -�� l��r `.-�' �������.-. �� �'�.�s��� Ku��-.�-I I ht.P � i��s��sf i� � � iz � z3 � l— �` � f— �, `1`{ .'f(o `�` � � {.` �, C �;��� � �o�t-`�e•.� �— IN-GROUND DOSED-GRAVITY DISPERSAL AREA Uniform Elevation Trenches with EZ1203HP Bundles 3-ft Trench (down-sizing credit) im�� ,z,. GeO1eX"1e I I ��vP��ao TYPICAL TRENCH Cover soi�coveR CROSS SECTION VIEW 1z• (No Scale) OBSERVATION PIPE DETAIL min.Irench depth (No Scaie) (hPi�q L —7- -- ,-1^� s��ew-ryaa o� F���sned c�aae sry cav(ioosa) �m„i�ned s saeaed� SystemElevation/io4��R � ' 4"BPVCPipe roPsouco�e� (typicaq ' Provide minimum 3ft a;o°aeo'ar��snaag��da ���������� separation between trenches. (4)1/4"-1/�••X 8"Sb�s (,il 90 apari TYPICAL TRENCH (Show location of inlet/outlet pipe connection on plan view.) n��no,m9 oe���e i�ru�ano� PLAN VIEW Su�aCe (No Scale) 4��g ooservaro„P�ae sn�u ba��s�auaa al junction between iwo uni�s. Perforated Lateral ObservationPipe ft — (typical) (typical) —— (typical) �� -------- �� r-- � � ______ __'____ �_-___ __ ___ ______' � A-3A ft D ------- L---------------��-------------- -----J — (typical) � 'r B= Co0 ft -� m (typical) G� INSTALL PER TRENCH: EZ1203H Bundle � (typical) � �0 10-ft bundles @ 50 ft`EISA/unit= 3C70 ft' (mfd by Infiltrator Systems,Inc.) � Install pursuant to manufacturers instructions. + 5-ft bundles @ 25 fl�EISNunit= fP =Proposed EISA pertrench= 3�� ft� Required Infiltration Area= �a� fP Distribution Method: x � trP.nr.hec-p�ppesed Totai EISA= Q���' tt° i�lr7uutcic� itec'�e��-�-va:��,y RESET PAGE50F6 SEPTIC / PUMP TANK SPECIFICATIONS (No Scale) � 4"0 Vent Pipe >10 ft from Building Electncal must comply with 12" Min. or 2.0 ft above SPS 316 and NEC 300 Established Flood Elevation Extend manhole riser as necessary. Weatherproof (typical) Junction Box Approved Approved Locking Manhole IMPORTANT: Vent Cap with Waming Label Attached + (typical) Anchor tank(s) as necessary �—Conduit pursua�t to SPS 383.43(8)(g) 4" Min. or 2.o ft above Established Flood Elevation � � (rypical) �Airtight Seal Finished Grade � Quick Disconnect 18" Min. CAPACITIES @ � �� � � gal/in �: � � . , . .�� � � � � • (typical} a. � � . . . � Depth (in) Volume (gal) A � O �j�; � , (y * � Weep � �Approved Joints with Hole Approved Pipe 3 ft onto B 2,0 3 � �Z A Solid Ground (typical) �C� ' l 1 � 3 z � : II�Alarm � � •� � 5� � �i '-� B �—On f [c] PUMP-OFF , * + Pump �_off : ELEVATION = 93 , ��: ft Pump Tank Liquid Level = 3 � in } I ° INSIDE BOTTOM Force Main Diameter = � in I Concrete ` + B'°°k ELEVATION = q(� • O � ft • • .. 6. • . Force Main Length = f 30 ft 3"Approved Bedding Material Beneath Tank Vertical Head = iN , ft Force Main Void Volume = a I � I q gal + Min. Supply Head = — ft [C] Total Dose Volume TDV = � � � , � 9 gal/dose 3 � u�, 3+ FM Friction Loss = � ? .t (5X total lateral void volume < TDV < 0.2X design flow) + (force main drainback volume) 5(�CS�SL�U t pp + Fitting Loss" = ft *(min. supply head x 0.3) MIN. PUMP DISCHARGE RATE _ � S gpm = TOTAL DYNAMIC HEAD = % �- �� t PUMP TANK: SEPTIC TANK(S): Volume = C2liQ gal Total Volume = � �� � gal Manufacturer: � ����L Manufacturer(s): �-Z � ` Pump Manufacturer: ��-��d� Install approved effluent filter at the septic tank outlet Pump Model: C-c(�� S .� (See attached pump curve.) immediatelv upstream of the pump tank inlet. Controls/Alarm Manufacturer: S,J-� Filter Manufacturer. ��Y'f:;,��c� Controls/Alarm ModeL f D�� Filter Model: �-T�� z�Z j Float switches containinq mercury are prohibited. . ' 3��� 1/3-1/2 HP fiam ion , . . � � .� � -.. , p �_ �_ _� � EFFLUENT/SUMP ��p Every pump tested in water to ensure pumb . ■ meets peformance curve. .r,.�-- � ^'�,,., � � i �.L� �t;..+�+: '�1._.,�� F '�-V�� �� ��� �"�.� '��$ I�„ ,��,�i;~'� ' ,. '�•• � � • •• • • . ,... - �� � lr.m. s-i�.. vyt _� I � • • , .� � • 1 • • • � , / • ' /• '�• � � . i'1�. .� � � • �, ' � �� � �� �' � •�• � � � •�' • � �. �'. � . � � �.� � • � � �• �� ,� . �' � . � �� � � ��..�. � •' • • • • � � �� . . � �� ��' �� � �� � � • �• �� � � ' �• . � � ��� / � ' � �� '�• �� � � � •�' � • � •�' • �� �� • � � � � / � � � � � • �� � "- . r.- , �_ _� �� ..�. �• • • � �. • � ' • �• .��'� ' ' � � ' • •• • •• • • • • - � . • �• � �• ' . .. �- -� • ' � -• • • • - • • • ' • • � ' • • � � � � .�.• � � . � 1 � ���������������������������������������� . � =��C■�ii�����i�i�■�i���i�i����������������� -,...��������..�.�����...����.��.�.����C��C������ .��������������..������.�...■■���.����.��.�..� ' ���������������������������������������� ���������������������������������������� ���������������������������������������� a������������������....������..������..�..��� ���������.������������������������������� . � �■�������������������������������■�������� �������■��■���a��������������������������� �����■���������������������■�������������� ���������������������������������������� ����������������a�����■������■�■����������� ' �������������=�����\������������/������� �������������� ���������������������������������������� ����������������►�`1��������������������� • ����������������il���'\��\\���������������� / ����������������I�■��Ir\������������������� ��������������������II��������������������� �������������������������\���������������� ��������������������������\��� � ���������������������������\������������� �����������������������������\����������� ���������������������������������������� �����������������■���������������►�������� . . ����������������������������������\������ �����������������■������������������������ �����������������■����������������` \����� ��������������������������������I����\����� ����������■■������■��������������r,�i���r�� ��������������������������������`-�����--� , �������������■����■�■�������■����������r������ ����������������������������������������� ����������i����i�ii������i������ii�ii��i . . ����������������������������������������� ������������■�����■�■■��������������������� , � � � � . .. • �. .. • . . . . . . • • :. : � . • . . . - . • ; , �� • • . . �� . . . . . � : PAGE40F4 In-ground Dosed-Gravity Management Plan IMPORTANT: The owner of this in-ground dosed-gravity system shali be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384,Wisa Admin.Code. Pursuant to SPS 383.52(2),N/isc.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 shail be performed by a registered POWTS Maintainer n accordance with SPS 383.52(3),Wisc.Admin.Code. Maximum Dispersal Area Operatinq Limits: Design Flow= �}SD gpd; BODS<_220 mgL-'; TSS 5 150 mgL''; FOG<_30 mgL-' Inspection Checklist INSPECT EVERY 3 YEARS o rype 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 distributian cell prior to dosing o dosing irregularities-if applicable(i.e.,pump re-cycling,float switch settinga etc.) electrical components-if applicable(i.e.,wiring,connections,switches,controls,timers,alarms,efc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure—compare to design specification) c 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 operetor licensed under s.281.48 Wi;. 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(s)shail 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[he 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: t{. 1K0.SVv�t-ISSe_V��- s6✓i S Phone: ?U� ��t Q' 3.�5 S� Local government unit SQ,W" c�• � Phone: 7�5�-fo 3�(—�L�� Local government unit address �t U 0.�'Y�� W� ZIP: ���icf� 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 shall comply with SPS 383,Wisa 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. Continqency 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. System Abandonment If use of this POWTS is discontinued,it shall be abandoned in accordance with SPS 383.33,N/isa Admin.Code. �"'�"``� PRIVATE ONSITE WASTE TREATMENT counry � > t`7, ? a$ ,�� SYSTEMS SaWyer �����,� �$ � ( POWTS) � �_ ,�� \h'"` V��`� INSPECTION REPORT Sanitary Permit No: ,,, Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �3 " �3� Personal infonnation 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�D#: �qt�S �.�.�w+Pl��t �'{c.�...�' — Insp BM Elev: BM Description: Parcel Tax No: , �oo.� � -� Slq� o�� - �Yo-aY- �3o6 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic ,,u;,ey�r - �� Benchmark ��p,a� Dosing "��J�o 6a Aeration Bldg. Sewer � ' Holding St/Ht Inlet Q y,� � TANK SETBACK INFORMATION St/Ht Outlet � TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet AIR INTAKE Se tic k ` �d� �-�c� .��` NA Dt Bottom �j Q�,r � P Dosing « 4 4 } NA Installation Contour Aeration NA Header/Man. 1 oS 3� Holding Dist. Pipe PUMP 151PHON INFORMATION Infiltrative � Surface �a`��S Manufacturer Demand Final Grade Model Number CS 3 GPM �{�`` {��'• (06.O� TDH (�„ Lift Friction Loss Sys Head TDH Ft Forcemain L �� Dia ,Z'` Dist.To Well DISPERSAL CELL INFORMA ION DIMENSIONS W ' L (�p' ` �` #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav � Conv ❑ Aggregate INFORMATION P�L Bidg Well Waters o IGP ❑ Chamber Model Number: ❑ AG � EZFIow CELL TO � •I-(dn� 'f'� +toa ❑ Mound o Other - -- --- - - -- - __-- --- -_ DISTRIBUTION SYSTEM X Pressure Systems Only Header/Manifold Distribution Pipe(s) X Hole Size ; X H� Observation Pipas C Length Dia � Length Dia Spac ! Spacing ❑Yes ❑ No � -- -- - -- -----—__- — - --- — —--_ 301L COVER - — De th Over De th Over De th of Seeded/Sodded Mulched p � P p - Cell Center Cell Edges ' Topsoil ❑Yes ❑ No ❑Yes ❑ 'Vo COMMENTS: (Include code discrepancies, persons present,etc.) ��s���� l o�Y �23 � — ��-- — __ _� � � � � Plan revision required?❑Yes❑ No I, �3 �or � II � �����'� � ��i'���, Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) A�OITIONAL COMMENTS AND SKETCH SANITAAY PEAMIT NUMBEA ____�"�3`''�_ ____ ��C�n�p ��o,,.., �, _� ���p0 ,"�`Q`a � � �N 1- � .��,�. g°,`"y �3 �, ;��?_ ,� ��`��---� -P f� ..p 3� 3� Yo U am• � � � �g� � � �/�., _� �� � � �� ( 3 � � `� � � .� � � � � � � � � �o <--� ��L l3`� �j�� g6d , -�- � ��,,,..� ��. l� s c a�'��-°--