HomeMy WebLinkAbout010-941-21-2210-SAN-2023-269 ��°-'�;%;, Industry Services Division � � ���� �b
� 4532 Madison Yards Way ou�c�Ga� •e�V—' S
_��:•=P � ' '� Madison,W'iSi705 SanitaryPcrtniW mber(tobenlledinby �
�� � _ �- I P.O.Box?302 �
~�\�m�' '�iadison.Wi 53707 (p 5� �y 5� W
sanit,dl�/�7e11nIt AppilCat�On StateTra�sactionNumber c�
In accordance with SPS 3R3.21�2),R'is.Adm.Code,submi,sion of�his foim m the appropriaa govemmental uni� �
is required pnor to obtaining a sanirary permit Note:Applica�iun Corms for staic-owned POWTS aro submitted ro Project Address(if different than mailing,.,.,.,,,,�
the Departmenc of'SaCery and Profession�Services.Personai information you provide may be used for secondary
purposes in accordance with Ihe Pnvacy Law,s.15.04(I)(m),Staa. I �-ry'I H (
I.ApplicaHon InTormation-Please Print All Tnforma[ion (J^ w�Ll w�r �`�•
Property Owncr's Namc Parccl r�
Sov�.-d(.�.� R . G��sS'e�- 0�0_4�t1_Zl_zz10
Property Owner's Mailing Address Pmperty I.ocation
l 0�04 uJ. rt'w�.� l..G�4 Q� G�.�.L��
Ciry,Sea[e 1 Zip Code Phonc Vumber ,`
T l4 l4Xt�`G�. l.l)� 5�{p L� I���-�(�-C{Z.�J I � �la� �..N�tl '/..Sec[ion Z�
^II.Type of Building(check aIl[ha[apply) Lo�= T � N R ��C E o
�7�'lor_>FamilyDwelling-VumberofBedrooms � � SubdivisionVame
Y-"
Block n
�ublidCommercixl-Describe Use
❑Ciry of
�SeateOwTed-DescribeUse CSMVumber illageofLI
38/y ��bsy �Tounof �T4�I W4N
iil.Type ot POWTS Permit:(Check either"Vew"or°'ReplacemenP'and other applicable on line A.Check one box on line B.Complete line C if
a licable. I--I_
A� �'ew Sys[em � �rceplacement Sys[em �[her Modification ro Exis[in,�,System(explain) �Additional Prttreatmenc L'nit�explain)
LJ
B' ❑HoldingTank �In-Growd �1t-Grade �Mound IndividualSiteDesiym OtherType(explain)
(conven2ional)
C. �Renewal BeTore �Revision .hanee of Plumber �t'ransfer m New Owner Lis�Prev�ous Permit Vumber and Date Lcsued
Expiretion �—
IV.DispersaVTreatment Area and Tank Intormafion:
Design Flou�(�pd) Design Soil Applicaiion Raie(gpd/sf) Dispersal Area Required 1sf) Dispersai Area Proposed 1s� System Eleva[ion
��j ..S 4oa r� � q3z r� ay.Zs
Capaciry in Total p of Manufac[urer
Tank Information Gallons Gallons []nits ' �$ _
Vcv�Tank.c ExixtingTankc I I c _n ' � .e
�`U n.7 a
Scp-c or Halding Tank I O�O _� D 1 (,(��,e se�-
l
Dosing Cham6cr � �
I
V.Responsibility S[atement-i,the undersigned,assume rnponcibility for insta arion of the POWTS showo on the attac6ed plans.
Plumber'sName(Pnn[) Plumber's5i a[ure � MP/MPRSnumber BusinessPhon<Numbc '
l� � S�l�vHz IS(6! �t�_5S�-S�o�
Plumbels Address(Street,Ciry.S�ate.Zip Code)
I 688 �-�-�I-� s o�t� L4��w� s�s�lp
VI.Co n /Departmen[Use Onty
�,p � ❑Disa oved Permit Fee ,Da�e Issued Issuin�Agen�Si�,mature
PP��/ PP� 5�/ y�/]������Q��L� '
y•' ❑Owncr Givcn Rcazon for Deniai 1�� � �U)�/'�3 i �"-/"`^""^' -�7�"�"`
oval�Reuons for Disapproval � �3 ,�� ^�� v� �
� �� � �p� y� �,i�,'�,� e�
PP I�C ,
Con mons o A�r r_�I��tlr'1i� ..—...��__.. .._. .. i
�
� � OCT 0 9 2023
CCs`� 23 - »�: 33�,► _ _ .
SA`JJYER COUNTY
ZONING ADMINISTRATION
Atmch to camplett piens for tM1e sys�em and submit ro the Counn'onl)'on paper not less than 8 li!�11 inches in size �y 5 i,�i
SBD-6398(R.oz/2?) N9 RL-FUt�Ds AFTER
I��UE UF F'�filU�l�i
Mni i
\
PAGE 1 OF 4
in-Ground Gravity Pian
Index & Cover Sheet
Component Manua!Design References:
Version 2.8, SBD-�0705-P (N.01/01. R. 10/12)
Pg 1 of 4 Index & Cover Sheet
Pg Z of 4 Piot Plan
Pg 3 of 4 Dispersa! Area Cross-Section & Plan View
Pg 4 of 4 Management Plan
Attachments: i Enclosures:
j FCWTS Application for Review
, Soil Evaluation Report & Site Map
Project Name / Description
OwnerName(s): �oh�'�"�eh C�IsS-e� Phone: l�S -�Z - 423�_
OwnerAddress: l0(�04 w �'c.��n I,.��le �a- ��-�ip: S`-�g`t3
Project Address: on � '���er- (Z� ��`1�-J 0.1^�
Govt. Lot: ti1 w 1/4 0` N W '�? Section�_; T�N-R�_E❑or W �
Township: � 4.0 w4-r � County: SG-w�e�
Project Parcel ID #: b in - �i41 - �-1 - 2-Z lD
Designer Information
Designer Name: ���Sv� 5 �� � �'�z Phone: -1lS - SS� - S4b
DesignerAddress: l (o8�d M��a�F � Sirone �r�4. Zip: 5`�g��
E-maiL• '
License Number: ! S/ (�/ Z�
Remarks:
Signature: �� Date: �����
p g al sign required on each submitted copy.
v/
G�-�her = ��L-- �� `
Srm4�E-fna.dt R . Ch �sSe.t-- S�w�er Co . f��wQ,•d ��
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�, B�t IDof n4�f, �:bbo�, 3'�P
�0�- 1 so,�-�k s:d� �q" w�;k �(�
� 1-7.85 c�c. $ l. G-[� (3'
Z 9-7 .65�
sC��e� (`= 40 3. 4�-YS`
'�a Bld��so. � -tes-�-Fire4C�nl� ,S 50.�5� sc��-p�. 4N.zS
� �rQ r,.ge Rzzs'—gs.s' �
a ro a[a !O [{O D 'd� S'QWCr+ Cls�Qjl
ST i� �' 45.5
.�f S�2G E WG�'��b,.� o i- �10 ntc 4��C'e Y .
� wc�� {"o n.�e�� Code s�6Ks
, Seplic 1 ank(s)Manutacturer: "
IN-GROUND GRAVITY DISPERSAL AREA � � �Se�-
S�plic Tank(s)Volume(s)�
��.e ed Elevation Trenches with Quick4 Standard-W Cham ers o �al ga'
pP I� g�� — �a►
3-ft Trench (down-�izing credit)
'�' ,�/ �� `ftluent Fflter Manufar,tumr.
�__�____�' � � � ._...�
�- ► _lll►-�- L_ S z s
���[' _ � -- ' -- min. 12"
SOIL COV[R �- _ (tyPlcal) Effluenl Fflter Mcxlel 11-----------------�
u — �
12" �
min. Irench .
-
�T�YPICAL "I RENCH �,��''n . . "
c�vr�i���1 _ - -. _- -- e Provide minimum 3 ft
CROSS �ECTION ViFW - - __--- -- ; ; . : ,� . � � . ,:
separation b�:tween trenches.
' 3h" --'d -----:"_I .o.
(No Scale) �----- (�yplcal) e ^ � . . �
�
- ---__
� _--�---- -- Lowest Trench (as applicable)
t-lighest Trench -------�---�
c�y 2� �y � ZS ft, ft; ..�.p_._.�.�._.-. ft; ft
System Elevations = ' ft;
ObservatlonPipn Typ�Lq�. TRENCI-I
c,lulck4 Standard-W ��YP��'�� PLAN VIEW
w! t=nd Cap �gr��W location of inlet I outlet pipe connection on plan view.) i„si2�i ��� m�„�,r��w��rs
.—� �lyp�Ca�� , Inslrur,tlons. �NU SCa�P�
_ ___ _- - - -
- - - --
-.- -� -
- --- -
-
_
- - - - /f_ ,, : ` n - s.o t►
___ -- --- -- -- �-
- -- -
� — - - —� -�� �� ° ., � �� � ��vni��i> 0
, � ;�; �� . �� �. _ � - �D
, , -- - =' -�
� , , : , -- -- - --
, -- �f-- -- �- ,
_r�- - - --- - - -
-- -- - -- --
- - I m
_ --- - _
ft ---- _ ------- ------
---------
- ------- -- ---------
C� = W
�-�--- - - (�uick4 Standard -W Chamber
�tYPic��l) (tYpical) �
(mfd by Inilltralor Syslems, Inc.) �
�NS-�-�1L�_ �ER T{�E,NCfi: �nstall pursuant to manufacWrer's instrucUons. .P
` 20 it� -L=1SAlchamber � y�� ftZ
23 Quick4 Std-W @ �
� 6 ftz EISA/pair = it2
�.. Pairs of end caps__ ___.@__ .___ _ _ �'l OO ft1 Disiribution Method:
= Proposed [ISA per trench = � b� ftZ Required Infiltration Area = —
c� 3 Z ftz ��.� � �
x Z _ trenches = Prop o s e d T o t a l E I S A = -
L���
PAGE�OF 7
In-ground Gravity Management Plan
IMPORTANT:
The owner of this in-ground gravi;y system shall be responsible for its perpetual operation ard maintenance pursuant tc
requirements of SPS 382-384,Wisc.Admin.Code. Pursuant to SPS 383.52(2),Wisa Admin.Code,this system shall
be considered a human healthhazard if not maintained in accordance with this aoproved management plan.
Furthermore,all inspection and maintenance activities shail be performed by a registered POWTS Maintainer ir
accordance with SPS 383.52(3),Wisc.Admin.Code.
Maximum Dispersal Area Operatinq�imits:
Design Flow= �s� gpd; BODS<_220 mgL''; TSS 5 150 mgL-'; FOG<_30 mgL'
Insqection Checklist INSPECT EVERY 3 YEARS
c type of use
c age of system
o nuisance factors(i.e.odors,user complaints,etc.)
o mechanlcal malfunction(i.e.,pumps,valves,switches,floats,etc.)
o material fatlgue(i.e.,leaks,breaks,corrosion,etc.)
o solids volume In anaerobic treatment tank(s)and any distribufion appurtenance(s)(i.e.,distnbution/drop boxes)
o neglect or improper use(i.e.,exceeding design capacities,prohibited activit;es,etc.)
c extent of ponding in distribution cell pnor to dosing
, dosing irregularities-if applicable(i.e.,pump re-cycling,float switch settings,etc.)
o electrical components-If appltcable(i.e.,wiring,connections,switches,controls,tlmers,alarms,etc.)
c distribution lateral or lateral onfice plugging (measure lateral distal pressure—compare to design specification)
o surface discharge cf effluent or sewage back-up into sVucture 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 W is.
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 ordinarce. Disposal of contents shall be pursuant to NR 113,Wisc.Admin.Code.
c Effluent filter(s)shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to ma�ufacturer's specifications. A servicing period will always be greater than 12
months.
System maintenance repoRs 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: �o�4��cL v� � �i�5S�r' Phone:��s—4 6Z—�-fZ.3 y
Local govemment unit: .�Z.W�¢�— C!) �(�✓����4 Phone:]IS—63�!— 82$�
Local government unit address: I v�A�� I r lG;� S� ��Q tt-�L�� ZIP S`-E 8�j? _
Any defective paR of this system shall be repaired.replaced,or removed pursuant to SPS 383.51(1),Wisc.Admin.
Code.Repair or replacement of failed or malfanctioning components shall comply with SPS 383,Wisa Admin.Code.
No product for chemical or physical restoration of the PO'JVTS may be used uNess approved by the department in
accordance with SPS 384,Wlsc,Admin.Code.
Continqencv Plan
In the ever.t that any failed treatment comporer.t of this POWTS cannot be repaired,it sha!I be replaced pursuant to
a plan submitted ro 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,Wisc.Admin.Code.