HomeMy WebLinkAbout010-171-00-2001-SAN-2024-029 : ' Department of Safety c°°"ty �
� = & Professional Services, � �
� _. Sanitary Permit Num� r(to e filled in by C�
'_ _ - Industry Services Division �
,: ��-i�� y . -�
S�1I11tilly Pe.Illllt AppllCilt1011 S�ate T'ransactio�Number p
In acwrdance with SPS 383.2t(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit �
is required prior to obtaining a sanitary pemvt.Note:Application forms for state-0wned POWTS are submitted to Project Address(if different than mailing address)
the Department of Safety and Professional Services.Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats.
I.Application Information-Please Print All Information CL'-iY�
Property Owner's Name Parcel#
,� :`S 7
`` � � (� —• — �C� — C�c�
roperty Owner' ailing Address Property Location
p ��, o .
City,State Zip Coc1e Phone Number
a r �.,�� _, � � 7f(�-_�f Section��_
Y
II.T pe of Building(check al1 that apply) Lot# 7' N R � E or�
C� � n � t��� SubdivisionName
� 1 or 2 Family Dwelling-Number of Bedrooms__� �-a.� \ '/
B ock# 6c.�vld` �� ��tCV`
❑Public/Commetcial-Describe Use
❑Ciry of
❑State Owned-Describe Use CSM Number ❑Village of
1Y�33� �35� �"ro�,�r ���
III.Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one box oo line B.Complete line C if
a lica6le.)
�' ❑ New System (�Replacement System ❑ Other Modification to Existing System(explain) ❑ Additional Pretreatrnent Unit(explain)
B' ❑ Holding Tank .�In-Ground ❑ At-Grade ❑ Mound ❑ (ndividual Site Design ❑Other Type(explain)
(conventional)
C. ❑ Renewal Before �Revision ❑ Change of Plumber ❑ Transfer to New Owner
ist Previous Permit Number and Date tssued
Expiration �-:�j�". �Y��� ���7.2
IV.DispersaUTreatment Area and Tank information:
Design Flow(gpd) Design Soil Application Rate(gpdistl Dispersal Area Required(s� Dispersal Area Proposed(sf� System Elevation
r
c' '� a
Capacity in Total #of Manufactur Y
Tank Information Gallons Gallons Units � � U � H ,� �
New Tanks Existing Tanks � o °3 ,�„ � P `° c°
n, U v� �, r� i.�. C7 A.
Septic or Holding Tank f �� �Z�C.G / ��t/' �,�. ' ,��/'
(
Dosing Chamber • �._-� ^7S� • ,
l
V.Responsibility Statement- 1,the undersigned,assume responsibility for installation of the POWTS shown on the attached ptans.
Plumber's Name(Print) Plumber's Signawre MP/MPRS Number Business Phone Number
_. ...__..._._.._
3Q i�"-� �-s- -/ ��
Plu er's Address(Street,City,State,Zip Code)
��S�i . � ^ . � � ` _ c
VI.Count /Department Use Only
�Ap o ❑Disappro�ed Permit Fee Date Issued Issuing Agent Signature
/� , $ � �.��� ���� ��.�����_
�!� ❑Owner Given Reason for Denial �•
Conditions of ApprovaUReasons for Disapproval � �-`.
,�"'� �� �" � �1a� a� � �
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�S 1 �`�—o�Y � s�a —
SAWY�R GOUN�'
ZONING ADMINISTi RA�Ec'si�
At[ach[o complete plaus for the system and submi[to the County only on paper not Iess than 8 1/2 x 11 inches in size
SBD-6398(R.03/22) NO REFU�IDS AFTER
+h,N IS3UE OF PERMIT ����� 3
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
OwnerName(s): �(,��,(n '� .(�J�'Sf�Op , `�I`► �P�,Vu.a�Phone: - -
Owner Address: ���r� /� ��°I,/�'1��C�t.QL�, �. �-��'G�y�t� �,,�Zip: J� �1:����
Project Address: SA1')'1,E
Govt. Lot: .1/4 of 1 /4, Section o��j , T �I N-R D�E ❑or W,�
Township: ���'!.(iIG;�� County: ��'Ll.C� C.��
Project Parcel ID #: (� � Q '" ��1 �' (� `- �I
Designer Information
Designer Name: �l� �}-�G�� Phone. /S ���5'- L,�J2�
Designer Address:� � m-Q � Zip: �J ���
��GGV..� � ,•, :
E-maiL• - ,
License Number: ���'f,'�(� �
Remarks:
�- �.�,v�-y'
Signature: Date:
j Original signature required on each submitted copy.
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Pe��t►�s�14 Rd
IN-GROUND DOSED-GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down-sizing credit)
� � �"—
"'"'" TYPICAL TRENCH
soi�c:oveR �N���� CROSS SECTION VIEW
"° (No Scale)
mi�,o-��on� _ —
a�pm
(�YPlcal) � '
�'___ 34.�'—� '. �
�iypicap �� Provide minimum 3 ft
����. � � separation belween trenches.
System Elevation=9S�d ft L�-/
��YPical) 7��..
Quick4 Slandarcl-W
wl Ef1d C8p � OUsarmtlon Plpc
(typical) (Show location of inlet/outlet pipe connection on plan view.) (lyplcap TYPICAL TRENCH
Inslall poi manufacturor's
msuuc�mns. PLAN VIEW
---- -��-------- ��— —�— (NoScale)
�QYC�b�RM�l1Y0!}A11pR.— ———�RYM�X!lk�MnY\IInMf�R
:�� , ,� . � �f �� A=3A tt
i La�w4ul�a���ar�Yi�lir ___._��_______�/�_—— p�iYY�YYMMYa�aiY111 J (�YPi�n1J �
— —' /
F--- -- B= Lj� ft — �----� �
(rypicap Quick4 Standard-W Chamber (Tl
(typi�al) W
INSTALL PER TRENCH: lmrd�y mriura�o�sysi�ms.�nc.) O
InStall pur�uent lo rn2nufacturer's Inslruclions.
�_Quick4 Std-W @ 20 fP EISA/chamber= z�-d it` �
CJ1
+ l Pairs of end caps @ 6 ft'EISA/pair= �_ft'
=Proposed EISA per trench=,�_ft' Required Infiltration Area= �iC` Distribution Method: �
x �trenches =Proposed Total EISA= ,�n' ^ r r- '�
/
RESET
I
PAGE 4 OF 5
GRAVITY-DOSED
SEPTIC / PUMP TANK SPECIFICATIONS
(No Scale)
4"0 Venl Pipe
>70 R/rom
Buildirg Elecin�l must compy wiN
17 Min.or 2.0 fl above SPS 316 and NEC 300
Established Flood Elevation W¢atherproof E#end manhole nser as necessary.
(tyPi�l) q��,� Junction Bmc
Ven�Cap APP�ved Laicng Manlrole
IMPORTANT: wim wamirg Label Atladied
Anchor tank(s)as necessary � � �ryP����
pursuant to SPS 383.4 8 --condui�
3( )(9) 4•Min.w 20 ft above
EsiabGshed Fbod Eleration
Mw�9
�AirtighlSeal �.
Finished Grade
Gate VaNe/
•Qukic D�'vmed
CAPACITIES @�gaUn � , �
e
Depth(in) Volume(gal) W�'��
A �` �.�� Min. Depth = in
.�n. j 38F �r �� „ 3�,sy� �''� � ,�,�_ �
B L.O � A Wa�ertyhl Gaskel
[cl �i. ��, �' �l�.$y I
� — ��'` �`13•y B n�„" �a,
[� PUMP-OFF
*Pump Tank Liquid Level =�in �° �—� ELEVATION = � ft
cnea�
D _ VaNe
Force Main Diameter= J in c«.:� INSIDE BOTTOM
g'�* ELEVATION = � , ft
Force Main Length = f f ft 3•"°°'°"ed Be°airg Ma�ena�eeneam Tank
Important: Bury force main below frost line or insulate
as necessary pursuant to SPS 382.30(11)(c), W.A.C.
[C] Total Dose Volume (TDV) _ � ,�gal/dose
(�sign flow-NO DRAINBACK w/check valve)
Vertical Lift = /8 ft
PUMP TANK: SEPTIC TANK(S):
Volume = �'�-C7 gal Total Volume = � �Q gal
Manufacturer. !//�`�S t=� ManufacWrer(s): 4�'i e5 r'�
Pump Manufacturer. z ��//ro�
install approved effiuent filter at the seatic tank outlet
Pump Model: /i Js� (�a��a���mP��� immediately upstream of the oump tank inlet
Controls/Alarm Manufacturer. SJ �-= /��nr^6�s Filter Manufacturer: �� � — ���p
Controls/Aalrm ModeL lC7��/ Filter ModeL• ����1�.�-,
Float switches containina mercury are orohibited.
�
�
� W PUMP PERFORMANCE CURVE
�: LL
MODEL 151l152/153
so
14 45 153
t2 ao
35
� 10 152
� 30
�
a
0 8 25 �51
� �
�
° 6 Za
15
4
10
2
5
� � � �
10 20 39 40 5Q 6C 70 8� 99 tOD
GALLONS
IITERS 0 40 80 120 160 240 240 280 320 360
FLOW P"eR AfINUTE
PAGE40F4
In-ground Dosed-Gravity Management Plan
IMPORTANT:
The owner of this in-ground dosed-gravity system shall be responsible for its perpetual operation and maintenance
pursuant to requirements of SPS 382384,Wisc. Admin. Code. Pursuant to SPS 383.52(2),Wisc.Admin. Code, this
system shali be considered a human health hazard if not maintained in accordance with this approved management
plan. Furthertnore, ail 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 Oaeratinq Limits:
Design Flow= ��� gpd; BODS 5 220 mgL"'; TSS <_ 150 mgL''; FOG _< 30 mgL''
Insoection Checklist INSPECT EVERY 3 YEARS
c type of use
o age of system
o nuisance fadors(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 negiect or improper use(i.e., exceeding design capacities, prohibited activibes, etc.)
o exterd 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, alartns, etc.)
o distribution lateral or lateral orifice plugging (measure lateral distal pressure—compare to design specification)
o surface discharge of effluent or sewage back-up into strudure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Septic and dose tanklsl 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 (113)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 Efftuent filter(s)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 witl always be greater than '12
months.
System maintenance reports 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: �U� .�/{'✓/� Phone �Ls—S�$'�(07 3
Local government unit: Phone: /�S �J3�C"��oZ' �
Lxai govemment unit address:`lI��,O ���� �7 t{,(,�(�ZIP: J `!%C�`GJ
Any defective part of this system shall be repaired, replaced, or removed pursuant to SP�83.51 (�),Wisc.Admin.
Code. Repair or replacement of failed or malfundioning 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
accorda�ce with SPS 384,Wisc.Admin. Code.
Continaencv Plan
In the event that any faiied 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.