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HomeMy WebLinkAbout030-737-36-5801-SAN-2023-242 ����" "' Industry Servi�es Division County � � � � 4822 Madison Yards Wa�� �U 1� �,' r' � �j� - Madison, WI 5370� $anitary Permit Number(to be filled in b�� � �i P.O. Boa 7302 /' . �� Madison, WI �302 lv S � G3 3`-}' � Sahita� 7�eY,m1+ A„„11Cat10n State'I'ransactionNumbcr � i- l, �J jJ � �_ � ` In accordancc with SPS 383.21(2),Wis.ndm.Code,submission ofthis form to the appropriate govcrnmental imit � is required pri�u to obtainin�a sanitar��pennit.Note:Application fonns for state-o���ned POW�I�S are submitted tu Project Address(if different than mailing ad thc Department of Salety and Professional Scrvices.Personal inlbrmation you providc may be used fi�r secondary E+�M� � purposc,in accordancc���ith the Privac��La���.s. I 5.p��I)(m).Stats. J L Application [nformation-Please Print All Infor►r►ation Properly Owncr�s Namc Parccl# b1 c�e + �t l e e h /V'�� I � � fl3o -?3?- 3�rSB� 1 Property Ow�ner�s Mailing Address Property Location � o N a t�,��� �d1� ��: 6a� C'it��.State Zip Code Phone Numbcr , � � f �KGlqh WL � - - - �Z� �9�' 27� (. ���. S W�/4. Section �� IL Type of Building(c eck all that apply) �-�r# T_ �_N R _ 7�A�or �'f or?Famil� D���cllin�-NumberofE3cdrooms � � SubdivisionNamc -„ 131ock� ❑ Public/Commercial-Describe Use ,� ❑City of ❑State O�cned-Describe Use_ CSM Numbcr ❑Village of i -- �fo�vn of t Qi��Olr III.Type of POWTS Permit:(Check either"New"or"Replacement"and other applicabte on line A. Check one box on line B.Complete line C if a licable.) �. ,�/ U Ne�c S��stcm Ip Replacement System ❑ Other hludification lu I�xistin�S��stcm(espltiin) ❑ r�dditional Pretrcatment Unit(czplain) �' ❑ Holding'1'ank �n-Ground ❑ At-Grade ❑ Mound ❑ Individual Site Design ❑ Other Type(e�plain) (conventional) t�• ❑ Rencwal Refore ❑ Re��ision ❑ C'hanec��f Plumher List Previous Permit Number and Date Issued ❑ �17,�nstcr t��Ne�c O���ncr Expiration II�V��. � IV.DispersaUTreatment Area and Tank Information: Design Plow(gpd) Design Soil Application Rate(gpd/sfl Disper,al Arca Required(s� Dispersal Area Proposed(st) System I{levatiun � ys'p •�1 � H� G � 2 �to.$ Capacity in Total #of , Manufacturer Tank Information Gallons Gallons Units � � o � � New Tanks If,risting"fanks � c a; � � � � r �--( u ffc,..�.�+t � � s � � �. � — st`ee Nk ` Septic or tiolding Tank ! O O o a���C'� O�O I Dosing Chamber C/l V.Responsibility Statement 1,the unJersigned,assumc rcsponsibilit}for installation of the POWTS s6orvn on ihe attached plans. Plumber's Name(Print) Plumher's Signatur MP/MPRS Numbcr Business Phone Number Ter�r 5��, hb Zz7��� 7�S �r6�S-7S�£s Plumber�s A dress(Street_City.State.Zip ode) i � �� �IC: r`c�• �Gw �k,� u�r�, ��►� fi`�i�S 7 ' V1.Co nt /Department Use Only �pp v ❑ Disapproved Pennit Fee Date Issucd Issuin�Agent Signaturc � f ��/J 7���,(�.,- � ❑OwnerGiven Reason forDenial � `�'� ���"�'�\1`�� � Ik''�"""'-�I �`�'�l/uci Conditions of Approval/Rcasons for Disapproval r-� i�� �,:--_� j',rn,,� � '�i � . (� r�V __.. r 'S)� ' � .�3 , .f�' ���� � � ,� � ■� ' �� _.. ._. . - °, "r r J ----- �! ` JCI�:. � �a a� �' �hk#�...a- � SEP 2 2 2023 � C1 — a.��. 3�� i �— ------ ---- ,S �-3 �Cv�� s.�},��,����=? :- . ZOlVIiJiaH�is`✓.�i;v; ;i; „, i Attach to complete plans for th .ystem and submit to the Counh�onh�on p:iper not less than 8 Y2 s I I inches in size ��s I '.i NO R�FJNDS AFTER se�-�39g�R.o2i2z> � I�S1JE OF P�RMiT PAGE 1 OF 4 In-Ground Gravity Plan Index & Cover Sheet Component Manual 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 Soif Evaluation Report & Site Map Project Name / Description Owner Name(s►: �O� � G + ���►� �c: N � Pnone: 9w - �Sq 3- 2?�2- Owner Address: ��,�, Zip: Project Address: �X'e jC.��(_� . �,(� � _ _ � Govt. Lot: _�_i�1/4 of S �1/4, Section �6 , T�N-R��❑or W� Township: � �(s�'�i�� County: SC�,w Project Parcel ID #: Designer Information Designer Name: �E?r(`� �c�(�P v���P_�7 Phone: t5'- - �6�- 7�7 S� Designer Address: W I "�`�j� u� L t�, ,�. _ Z�p� ��'l� S 7 E-mail: ! V �� ��.� U �O Ur+� �� License Number: 2 2�j�' / Remarks: � Signature: Date: 2 23_ Original sig ture required on each submit d c y. „ar 3 af 3 CHECK BtTX AS APPLX".ABLE• � CHECK BOX AS APPL�LE• � SOIL EVALUATION S"�'�� '”-�0' �'SYSTEM PAGE 2 OF y SITE MAP ° � 75 1� PLOT P�AN PROJECT NAME: DesIGNFl.ow: �I SO GPD ,r t12���9� 2�� Attach design flow calculations tor commercial plans. MG tt�Ao� �Of. PROJECT ADDRESS: l�OCJ/V ��I e b e e �• Pipe Materiat/ASTM Standard(7ables 384.3Q3&384.305) /0 0. Q � � Sanitary Sewer. / BM 9ymhol: � BM�evaUon: � Force Mairc / BM o��on: �o�o w� S i�i n a S w C o r ►� e r f eS. Fnalcate rartt,by IMPORTANT: Slope Gra�ent(°/o) �� Well Symbot(If applicede): Q drawing en errcr�v Show ground elevatlon contcwrs at suitable interva�. of Tested Area: � on rne aaP���- ; ' , � ' I � f . i , �_ '.. ;_.... ... _ _ __. ; �, _. � ; r , . ; � , ' , _ � _ ; ; - '. Q� � o,�a� 3��65�a�r :._ . _. � _ k f __ . . . _ _ _ � . _ _ ._ _ _. _. . _ _ . . � . . .... . . .... .. ��� , , � � o.;c i . .. .. � ; , .. . - . ; .._w ... .. . __..___ __ . . � .'' .. _._ .... _.� .:_. .�. . ;.. , _._. _ __ ._ . ; �.. . _.. .:._ _� ° ;__ _ � :.. ;. 4 � � � I..... .. ....,�.. ........... � . .�.... ....-...�..: ...� .,�� .. ���, .. .... .� . � � .�. . _.. .. .. �..�� �'� _._.� �_ .. ... ... • l I . , _ v �' �• ' . ..J... -. �... � �. ..�.... �....:.. 1 . .F... ��« ... _.. ... I. ' � , ..�..._.... .�.. ..;. ..., q�'R .., ... _. .- ... . . ... . 3,..... __. ., ... ... .. - . '� ��. �; .. ... .:. r .. . . ...'�. . ..,.,..._ � r y . �' ' � . � . �. . . �' : � '_ ._ __ . ... . __.. 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I _ _ � _. __ .. , ; � . : _ . :_ � � f�FS. i : . . . . , , . �� , � , � . l � . _ : _ . � . . . , � . . � � _ .__ � : __T , .. ; ______ . . '. � �` i�o r� �--- ��n.,��. _ I _ � --_ ; _._ ; - - : � _ �--- ---.-- � __- -- fi � � , - --- l t, _ ; � ;_ . .. -�._., eX.isf'�h�c SeQ�';c ar- c;- � -- � � � _..� � I°_� le �e e Se�ePa�,e sy.�te� .. _ . _.... _. .._:... _ . :_. .. .. ._. � . �' _ � _� , � �---- � d _ __. � �. h a_�. �..a.r_� _ . __ _ -- , . ., �. .. _ .. _ _ { _. .,.... � ..�.. .._ . :. __. . _;._ ;. _ .. _ . . . � _ _ _ ? � 1 t . � o t � ,, � ,):_ i I � ; � R �� : �a�e � .. YJO t"�,n,p S � � �_ $ _.��. .. _ I _! . :,. . _. _ _ . � _ . : �'s` _ _. _ . _ . _ . .. _ -' � _ .. ; . . . . _ vM. � � _ �ydY. _ :. � � � ' _. . . _ _ - - � ; � � ; _ �- . �� o .. _ � _ - . : ! � ' ` � _ _ _ _ _ . _ . : � : ' _ 3 95 3 . __ - -- ; � __ _ _ / Co►��ou�r :..�i_h�S � t �� : � � __ ._ _ . _. . _ . , , � . , _ , _. . , ; , SC�i4E��ERG SOI:�TEST�NG _ _ _ . : .. ; � ' .., . .. . _ , . { 1��i;i315 Mud l.ake R�ad _. ; , ; ; I _ _ . _. I :. ,.. . ; . Naw-A��um;-N!E 5475-7 ; ; i �.. . : _. P�;'fX,(li 5}.�58 7&78 :.__. �;- 2_�l�.�,.� -._ _ _ . . _. � . ._.._._ , .._ .. � /� ��� � , __ __. _ ___ __ _ Sep c ank(s)ManufacWrer. IN-GROUND GRAVITY DISPERSAL AREA I-I� �.���-. t1 �o��� �a I �— Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Volume(s). 3-ft Trench (down-sizing credit) gal gal gal gal ,I/ `I' Effluent Filter Manufacturer: W W � » I y� Effiuent Filter Model#: 1�P�,�- ��� � �� in.�2' SOIL COVER (bpicai) 12 m'n.irench depfh �ryP�a�� � • TYPICAL TRENCH � 34•. a <; CROSS SECTION VIEW �cYP��a�� (No Scale) ' ° t— Provide minimum 3 ft 5ystem Elevation=�d.J ft separation between trenches. � � � (typical) � , � Quick4 Standard-W � , � � W/End Cap ODservationPipe TYPICAL TRENCH (rypicap (Show location of inlet/outlet pipe connection on plan view.) (rypical) InstallpermanufacWreYs PLAN VIEW instructions. - . (No Scale) ------ --�f------�—�f---------- --� � • -_ „ �:; rEi � i : � ��: .s : �� A=3.Oft �_—__ � ___J (tYPical) � -------�f--------��----- D F B= C�S ft —_-; G� m (typical) Quick4 Standard-W Chamber W . (typical) O INSTALL PER TRENCH: �mra bY mrnvaco�sYscams,i��.� � Install pursuant to manufacturers instructions. � �6 Quick4 Std-W @ 20 ft�EISA/chamber= 3 2-Q ft� + � Pairs of end caps @ 6 ft�EISA/pair= � ft� =Proposed EISA per trench= 32 6 ft� Required Infiltration Area= ��.� ft� Distribution Method: x 2 trenches =Proposed Total EISA= �S� ft` �o���� ������ 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 accordance with SPS 383.52(3),Wisc.Admin.Code. Maximum Dispersal Area Operatinq Limits: Design Flow= _ �� gpd; BODS<_220 mgL''; TSS<_150 mgL-'; FOG<_30 mgL'' Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system ' o nuisance fadors(i.e.odors,user complaints,eic.) o mechanical malfunction(i.e.,pumps,valves,switches,floats,etc.) o material fatigue(i.e.,leaks,breaks,corros�on,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 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 specifcation) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS(or when necessary) o Seotic and dose tankls)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)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 filterls)shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servici�g 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 ma�function to: Name of individual or company: �c��.��r� • „�;c, � �� Phone: ='Z 'a ��� Local government unit: — Phone: Local govemment unit address: �G� I C) �����^` �- �a v,,,a rn ,1��ZIP: S y�S`I 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 with SPS 384,Wisc.Admin.Code. Continaencv Plan In the event that any failed treatment component of this POWiS 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.