HomeMy WebLinkAbout002-157-03-1001-SAN-2023-241 ,
�:��.�� ,.:. c�u�n�
. Department of Safety � �
5c�c�.� `It-f
F ! & Professional Services,
is �, $� Sanitary Permit Number(to be filled in by C `�
� ; � � Industry Services Division � �
� � Si ' '
�° (�;� � ,�
Sanitary Permit Application StateTransactionNumber �
� �
In accordance with SPS 383.21(2),Wis.Adm.Code,submission ofthis form to ihe appropriate governmental unit �
is required prior to obtaining a sanitary permit.Note:Application forms for state-owncd POWTS aze submitted to Project Address(if different than mailing ad< .-G
the Department of Safet}�and Professional Sen�ices.Persunal�nformation you pro��ide ma} be used for secondarc �����.� ���� ��� '-"
pu�poses in accordance�tiith the Pri�•ac��l.s�c.s. 15.01(11(m).Stats-
I.Application Infarmation-Piease Pri�t Ail infarmation
PropeRv(T�mer�s Name Yarcel#
�ds��� � �T�,w, , `c��c- �.v o�,a�s'7c� 3 i r�� t
Property Owner's Mailing Address Property Location
1 yisv ,,� P�,� ►�' A ��-- Go�-t.Lot
City,State Zip Code Phone Number
�„��� �� �� $ �( ;af 3 '/a, '/a, Section 3�
II.Type ofBuilt�ng(eheek ali that appiy) L�t� I `"�V N R "` E or�
�1 or 2 Family Dwelling-Number of Sedrooms ,..? �p~�� 2�y 3� Subdi��ision Name
Block#
❑Public/Commercial-Describe Use �✓� �
❑City of
❑State Owned-Describe Use �A CSM Numbe� ❑Village of
,�To�sn of Q�.S.`7 �-ts��CG
III.Type of POWTS Permit:(Check either"New"or"Replacen�ent"and other applic�blc on line A. C'heck one box on line B.Complete line C if
a ���licable.)
A' �New System � �
❑ Keplacement System ❑ Other�vfoditication to Existmg S}�stem(cxplain) ❑ Additional Pretreatment Unit(explain)
B.
❑ Holding Tank In-Ground ❑ At-Grade ❑ Mound ❑ [ndividual Site Design ❑ Other Type(explain)
(conventional)
C. ❑ Renewal Beforc ❑ Revision ❑ Chan�e ot�Plumber ❑ Transfer to Ne�v Owner
ist Previous Permit Number and Date Issued
Expiration
TY.I�i� ersx�'reatoteut Area and Tank iuformation:
Design Flow(gpd) Design Soil Application Rate(gpcUs� Dispersal Area Required(s� Dispersal Area Proposed(s fl System Elevation
L�5� � �- Co ��� Co�-a-. �-5�c� •�
Capacity in Cotal t!of Manufacturer
Gallons Ciallons Units ` o b �
Tank Information � U �
New Tanks Existing Tanks � o �' 2 � � �° �
a U v: � v: iz. C� o..
Septic or Holdiog Tank 1�l.�,,„ ,�� j� I i ` ' ��. �
+ 1 a✓l/
Dosing Chamber
V.'sRespoasibi(ify Statement Y,Che undersIgned,assume responsibility for ins�►ll:�tion of the PO��'"�S shown on the attached ptans.
Ylumber's Name(Print) Plumber�s Si�nature MF'/MYRS Number � Business Yhone Number
Jerry Ruid Excavating, LLC ��� � 2�z�6 j- j"���_ `E`t 2��`��`�
Plum r e, 'p Code)
Stone Lake, WI 54876
Vi.eouu lDeparfinent Use Onlv
Pcrmit I'ce Date Issued Issuing Agent Signature
� A � 3 ❑Disapproved
❑Owner Given Reason for Denial $ `��'• �� I�� '�� 'n��'""'--��'" --
Conditions of ApprovaUReasons for Disapproval
� � � a� �3 � � �� �
� W� � ��� �ar� � �
� i Chk# 3�� � - SEP 2 6 2023�
CS � �3 "' 1 5 � ���,�:�,_ ,��i'73_._._._.�._._.._.e. ��;'NYFR C�' '^.:-;�,
�.�i�1.iC��7 AL!Mif4i�i=�
Attach to complete plans for the system and submit to the County only on paper not less than 8 U2 x 11 inches in size � .�� � I
sBD-639s�x.o3i22� NO R�FUN��AFTER
�S�{JE OF P�RJUoi?
' CMECK BOX AS MPIJCJ�BLE CMECK BOXAS APPIJCJ�BIE,
� SOIL EVALUATION o �1e:�'+'0' � � � SYSTEM PAGE 2 OF
SITE MAP PLOT PLAN
PROJECT NAME: ��� DESIGN FIDW: ys G c�
�G{a,ry ACach design flow ealwlatioru for commercial plans.
P�JECinDD�ss: �y2CnSW l�lC� �P. PipaMateAallASTMStandaid(feWes384.3038384.3U5)
sM a�rmed:� sM��: 1 ao.o � N senrc+n sanar 5�"�ti '-f L'�c1c,
Face Meln: N.PC /
BMOtlC11�1011: ROIT�N io" �a-S O�k
SlopeGradMrd(%) ��a Wdl M Inda: anwi enmo IMPORTANT:
d Ta�ea am: �"��°� � O ����� Show g'ound elevatlon conburs at auiteWa intervels.
� C(Z.Cj
2. CS7��
3 �7. �
`�`j STGr-,� - cc5.� - �2 2.�0
I�rapose� ��.i���wsy-`3g,p h'
Pro,posc� w�(! �ro r�ee�7' sei b�.c.l:5. �
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l .
i
µoose.� /
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Jerry Ruid Excavating,LLC �_oed
W208 County HWY A
Stone Lake,WI 54876
G5` - z�-t2,2�,�
Ml�a`a
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R�n-I
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IN-GROUND GRAVITY DISPERSAL AREA rv�es�'�`Td�`�'��
Uniform Elevation Trenches with Quick4 Standard-W Chambers ���Te�k�,�„d,,,,��„
3-ft Trench (down-sizing credit) 1�; � _� _ � _�
EMuent Fiper MaxRacWre[
�I� �i��QTtv.t�'
I �
EfAuent Filtm MaEel# �T
m�n ir
SOIL CAVER (Hwm�
12
mia0enrli
JepP
�"0'�'� � TYPICALTRENCH
� � "'.<�-.. CROSS SECTION VIEW
�.
` mo� � _ (No Scale) �
•� • � � � Provide minimum 3 fl
System Elevation =��� ft seperation beM�een henches.
(rypica�)
�uick4 Stantlartl•w
w�HP���P (Show location of inlat/outlet pipe connection on plan view,) ��"irya�j°° TYPICAL TRENCH
'"'�"ue,^�^�m.e,.r• P�N VIEW
��'""�"� (No Scale)
r -- -- - - - - - -�f - - - - - - - -1f - - - - - — — — �
IA= 3Oft
L - - - - �r - - - - - - �r - - - ���, n
� _ s = � n � m
(ryP���� Quick4 Standartl-W Chambar W
INSTALL PER TRENCH: «�� �
(�rtaMmero.m.sYemrrm.irc.) T
�Quick4Std-W@20ftEISAld�am6er= 32C� ft' �"sm�p�""°ncmmenu�ecwrerc�struuvi,, A
+ � Paira of anC qps�6 ft EISPJpeir= � �ft'
=ProposeC EISA per trench= 3�� ft' Required Infiltra0on Area= �k 3 ft' DiStribUtiOn MBthOd:
x '� trenches = Proposed Total EISA= �v7 a= L�r�w caY
�
PAGE40F4
In-ground Gravity Management Plan
IMPORTANT:
The owner of this in-ground gravity system shall be responsible for tts perpetual operation and maintenance pursuant to
requirements of SPS 382-384, Wisc. Admi�. 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.
Furthertnore, all inspectio�and maintenance activities shall be pertormed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3), Wisc. Admin. Code.
Maximum Disoersal Area Ooeretina Limits:
Design Flow= �S� gpd; BODS<_ 220 mgL''; TSS <_ 150 mgL''; FOG 5 30 mgL''
Insoection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors(i.e. odors, user complsints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches,floats, etc.)
o material fatlgue (i.e., leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treatrnent 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 exterd of ponding in distribution cell prior to dosing
o dosing ircegularities-if applicable(i.e., pump re-cycling,float switch settings, etc.)
o electrical components -if applicabie(i.e., wiring, connections, switches, controls, timers, alarms, etc.)
o distribution lateral or lateral orifice plugging (measure lateral distal pressure-compare to design spec'rfication)
o surface discharge of effluent or sewage back-up into structure served
Malntenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Seotic and dose tank(s)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)ezceeds 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 EfflueM filteHs)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
moMhs.
System maintenance reports shall be submitted to the proper Iocai government unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to:
Name of individual or company: J�Y'Y �u� �-��.-c�-i��✓S Phone: 7`S �-Cg 2- �- k�Cl
Local govemment unit: S�- '�- Phone: �'s� 3`{ �2�f;'�
Local government unit address: ���-�v �"n���v � �• �'��-�490�'��• �s- ZIP: j`{`a `�3
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,Wisc. Admin. Code.
No product for chemical or physical restoration of the POWTS may be used unless approved by the department in
accordance wfth SPS 384,Wisc. Admin. Code.
Corninaencv 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.
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