HomeMy WebLinkAbout010-941-33-1326-SAN-2024-017 • Or�9
/`� j Indus[ryServicesDi�iabn �'.C nry (��
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��=P '',= Madison.�l'i 53705 I Sani[ary Pertnii h'umbe(ro be niled in by Cc Z
''� � t�'. � P.O.Box 7302
��`�;�/j��� Madisan.\i'I53707 (p s�`�� �
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Sanitary Permit Application StamTansaaiooNumber �
In accordance wi�h SPS 383.21�2),Wis.Adm.Code,submission uf chi.s�oRn to the appmpnace aovemmental unit J
s rcquimd pno�[o oblaining a sa�i�zry permi�.Notc:.4pplicacion Cortns for statc-owncd POW?5 are submittcd co Projcct Address(if differrnt than mailing adamss�
the Departmen[of Safery and Professiona�Services.Personai information you provide may be used for secondary
purposes in accordance with Ihe Pnvacy Law,s.15.04(7)(mJ,Sta�. rJ \
I.ApplicaHon information-Please Print All Intormation �4�'� �C
Propercy Owncr's Namc A���:[- Parccl=
� a �-an� ��.c a�,� �� ��cre, 'ti.�,w . p�D --r*41-33 -13z�
Property Owner's Mailing Address Propeny Location
►szs2� W. F{os ;�'�� R�
Gnv�.Lo�
Ciry,S�ace Zip Code I Phonc Number
�4 w�r� � I 5`18'�3 �602 _�oL_6341 ; Sw�..�� ��.se��,o� 33
II.Type of Building(check all tha[apply) -Z Loe= T � N R �r( E o W
�Ior2FamilyDwellin�-NumberofBcdrooms _J Z SubdivisionVame—
B�ock 1
�ubliciCommerciai-Describe Cse
� ❑City of
❑StateOwned-DescribcU.�e [SMNumber iilageof
2� Z'-1 �/�.3--� �Town of .4�I(.J4`n
b
III.Type of POWTS Permit:(Check either"rew"or"ReplacemenP'and other applicable on line A.Check one box on line B.Complete line C if
a licable. �-1_
A� �'ew System � pceplacement Sys[em ��[her Modification to Existina System(zxplain) �Addi[ional Pretmatment Unit(explain)
I LJ
B' ❑HoldingTank ��In-Gmund i�1i-Grnde �Mound individualSi�eDesign OtherType(explain)
(com�entional)
C. �Rrnewal Bef'ore �Revision hange of Plumber �ransfer[o new Ovmer �sr Previous Permii Vumber and Dece L<sued
Expirntion —�
IV.DispersaVfreatmeut Area and Tank Informafion:
Design Flow(gpd) Desipn Soil Applicaeion Ratc(gpd'sp Dlspersal Ama Required(s� �Dispersal Area Proposed(sQ System Elevanon�
.So .�7 6�3 6az 4s,o
Capaciry in Total ;of Manufacmrcr ,
Tankinfortnation Gallons Gallons i L'nirs ( a �, I V� '
vcuTank Exi.c�in3Tank� '� - - � A
�C% ;n .i.Ci 0.
p orHoldi�gTank ��qa.� `� � we�uy-
3N
Dosing Chambcr O �
V.Responsibility S[atement-i,the undersigned,aswme responsi6iliTy for(nsMnllaHon of the POWTS shown on Me attached plans.
Plumber's Vame(Pnnt) '.Signamrc �� I MPiTRPRS Kumber Business Phone Number
Ro6 �P�q�c� I Zzla z�B ��s _6��-ds36
Plumber's Addrcss(Strcet.Ciry.Sraie.Zip Code)
�45'�9 w s-f- -�{w� �1`t �.r (,v l S�-t s�t3
VI.Cou ry/Deparhnent Use Onty
�� ��ed G Disapprovcd 'Permit Fee Da�e Issued i Issuin�Agent Signature
Y �° ' .� I�u ; � ,�
❑Oumcr Givrn Rcason for Drnial ��� �A i I� ��
Conditions of Approval,Reuons for Disapproval ��1�-�r��,�I,y i�,��,..a,C,�
���GI���L �;���;�� .s��_ i�,;} ,,
.. � �y
�I�J�; �.� FES O 7 2024 �
�S � �-( — � I� ?51 SAWYE�i Cf,l:.:idTY
AttacM1 to complefe plans for[he system and submi[[o the CounM1'onl}'on paper notleu[M1an A 1/'x 71 inthes In size I�� I
SBD-6398(R.02!22) NO REFUNDS AFTER
ISSUE OF PERMIT
PAGE 1 OF 4
In-Ground Gravity Plan
Index & Cover Sheet
Component Manual Design References:
Version 2.1, SBD-10705-P (N.01/01 , R. 10/12) . . .
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
Soil Evaluation Report & Site Map
Project Name / Description
Owner Name(s�: .�2n , �s �e� l� ��rc� Phone: 6oZ. - yoz - 63q�
Owner Address: /s ZS4 w � l�os�,-�4 I �1 �"fa�wg n� Zip: S�f-S `�3
Project Address: 6 ►� �� r �� (� �-
Govt. Lot: s�-�.1 1/4 of 1� � 1/4, Section�, T 4( N-R � �l E � or W�
Township: � � wc�r�1 County: S�w � �r�
Project Parcel ID #: O l O --- �41 _ 3 3 — I 3Z-(�
Designer Information
Designer Name: t'�.C� � l�� C��.rTP Phone: � �� -b�- O �r 3(v
DesignerAddress: 1� 5� �i � � �� z�7 �-��ti �4`'c� Zip: S`-��`�
E-mail: '— ..
License Number: �--Z�(v Zl �
Remarks:
.Y -��. '� 7 � �`�
Signature. � �� �� Date: Zry �
Original signature required on ea py
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�--------__________-__—_
Sepllc T�ank(s)Manufaclurer: '
IN-GROUND GRAVITY DISPERSAL AREA 1,���se�-
Stepped ��evation Trenches with Quick4 Standard-W Cham ers v
Septic Tank(s)Volume(s):
3-ft Trench (down-�iZing credit) �op ga, _ ga, �a, gal
��— I �FfSluent Fflter Manufar.lurer:
��!-..�_�_�__--`�- . _ -_��_�__ o l (D
_ _ � �,�;��_ '�-
�� SOIL COVGR � -min.12" Sz�
-��yp�cal) Fffluent Fllter Mcxlel i!� -- - -— —___`_
i
12" — �
min.trench
7�YPICAL�TRENCH ����,n - �. "
�ry�i��i� rovide minimum 3 ft
_ --- . . ,.a..n .,.
___ - , . : ,.
CROSS �F_CTION VIE -- , . . . separation bc:iw�:en trE�nches.
� (No Scale) <<vc�i��>'--e^-"� � .
f�----- � a
----------
�___._�_____- �.owest Trench(as applicable)
t-lighest Trench -
� � , ft; ft
q� ft; --
System Elevations=� ���,,..� ft, ft; �� --�
Obsorvallon Plpa Typ�Lq�.l-RENCI-I
czutck4 Standar�-W �`yp'°''> PLAN VIEW
wi t:nd Cap �Sh�W loc�tion of inlet 1 ouNet pipe connection on plan view.) �nstall per mamdacturor's
-- (lyplC�l) , Inslructlons. ��f O SCa�@�
_ ___ - -- -
/� _ _- -- y , , - __ ._- � ,-;�-, -
_ - - - - �'i` — � - , - s.ort .
- ---�._ -- . I
n�- -t7
� _ - ���- `, �; � ���`�� pyn�oaq Y
, ,i, ,
�� ;., . ;, i � ` = — ---�'�-- - �_ _ _l � --
— --- -- - �
'� - . -��-- - -- --- - - --- - ��- -- m
�---� -- :.__. _�.- . - - -� - - -�-- — --� - . ft � �---�---- ------------- --�------------��
----------- -- -
-- r� = _ w
�-�'---—-" -(�uick4 Standard-•W Cham er
�tYPical) (�Ypical) o
(mfd by InfllUalor Syslems,Inc.) �
�NS'�'�LL PE�TRE.NL.H: (nstall pursuanl lo manufaclurers instructions. �
�� Quick4 Std-W @ Z�i���SA/chamber= �,�,� ftZ
6 ft GSA/pair= � ft2
+ , Pairs of end caps @ z �' _____. --
—_ —�— 34�o ft2 Required InfilUation Area= �� ft` Disiribution Method:
=Proposed EISA per trench= _._____�
x Z. trenches = Proposed Total EISA =
(��tZ f�2 r�v'�
....
aAGE�OF�
in-gro:�r?d Gravity Managerr�ent Plar+
IMPORTANT:
The ow^er oi:hs ir-ground gravity system snali be responsible�cr its perpetual operation anc maintenance pursuart to
reGuiremer:s ef SPS 382-394,'JVisc.Adn-:-.Code. Fursu2r,t to S?S 383.52(2).Wisc.Admin.Code,this sy=tem shaii
be cor.seered a".ume^.`��eai;n 7azard i�not ma;^taned in accordaace wi:h this aoproved man2gement plan.
F��rtnerrr.ore,2il inspec?ior.ard mainten�nce ac:ivlties sha!i be perforr!ed by a registered P01NTS Maintainer in
acccrdar.ce with SPS 383a2(3j,Wlsc.Adnl.r,,Code.
Maximum Dispersal Area Operatina Limits:
Design Fiow= �"S� gpd; �ODS<_220 mgL''; TSS<_150 mgL"''; FOG 5 30 mgL"'
Inspection Checkiist lNSPECT EVERY 3 YEARS
c tyoe cf use
c zge o�sys:2m
o ^uisance?z�tors(i.e.cdo�=,user�ompiair.ts,e!c.;
c mechacicai^�aiiuncf;cn;i.e.,pumps.,vaves.switches,floats:alc.�
material�zt!gue(i.e_le2ks,�reaks,corrosion,etc.)
o soiids voluume i.^.araerobic:reatmert tank(s)and any distribu:ion appurtenarce(s;Q.e.,dstribution i drop boxes)
o r.egiect or improper use(i.e.,exceeding desigr capacities,prohibited ac.ivities,etc.)
extert o'oondirg in dls;nbuticn cei'�.pnor tc dosing
c dosing irregu!arities-If app!icsble(r.e.,oump re-cycling,fioat switch settirgs,etc.)
o electrical comocner;s-'�.f zcpiicable(i.a.,wir:ng,connections,switches,cor.trols,timers,alarms,etc.)
o cistributior.latera:or!aterzl or.fce o!ugging (measure iaterz'distal pressure-compare to desigr.specifcation)
o surf�ce discnarge o*e�?;ue^t or sewage back-up intc s,n:cture servee
Maintenance Checkiist MAIR�TAIN EVERY 3 YEARS(or when necessary)
c Seatic and dose tanklsl sheli be pumped by a cerii5ed septage servicing operator licensed u�der s.281.43 VVis.
St2ts.when fhe volume of solids in the tank(s)exceeds one-fhird(1l3J the liquid volume of the tank(s)or
as reouired oy Icc2l ordinance. Disposal ot corterts sha!i be pursuar:to NR^?3,Wisc.Admin.Code.
c Effluent filter(s;shall be i^spected every 3 years ard shal:�e deaned when necessary to remove any
accumul2ted solids accorcinc tc manuT2dure�s specifcatlo.^s. A servicing�erod wil;always be greater;han 12
mc.^.ths.
System maintenance reports shali be submitfed te the proper local government unit in accordance with
SPS 383.55 W�sc.Admin.Code. Repert any component failure or malfunction to: Q�3 �
i �G.6 t�4 b4rc� ��l�q Phcre:-!I�-b'l�t- -
N2me of individua,or ccm,pzrY: 634-SSZ-SS
S��.0 -c r C o �o vi�.�
Phone: �IS-
Locai goverr.ment u^J`.: �
Local goverr,ment unit address:
�o bto tvl�' S-� � �i4 �-�w�rd l.e�iP: Sttss -3 —
Any detective oart cf this system s�.a!!be rec-;'ed,rep!aced,or removed pursuant to SPS 383.51('),W�sa Admin.
Ccde.Repair or replacemen;e*railed or mzifunction',ng components sh211 ccmply with SPS 383,W:sc.Admin.Code.
No product?or cnemic2!or o^:ysirai resior2tior oT:he FOVVTS m2y be used unless approved by the departmer.t in
accordance with SPS 384,Wisc.Adm��.Code.
rnntina_____encY P�a�
In:he event:na:�ny railed treztment compo�er:or�h.i=?�W rovF r'A f�led?n g ound�spersalecomponent may be
a plar,s�bm:Yed:o'.^e aopropriate agen�y�o�review and zpp
abandoned and rep!2ced by a code-com I i^ �ispers2!comoonent:r z pre-detemi^ed arez of suit2ble soils.
Svstem��dO°ment
If use ot this POW?S is discontir.ued,i:sh2il he abendonec i.^.accordarce wi;h SPS 383.33,Wisc.Admir..Code.