HomeMy WebLinkAbout010-941-21-3425-SAN-2024-063 • Or�
- �� I IndustrySenicesDi�iaion �Counwt (n
i 4S'2'NadisonYardsWay I J4W�e4- D
,,SP '- � ^Aadison,Wi 5370' Sad�ary Pcrmic?:umbcr(co be filled in by �
; _ ; � P.O.Rox'302
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�b�;�/ Madison,Wi 53707
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State Trnnsac�ion Number 1
Sanitary Permit Application �
(n accordancc wi[h SPS 3R3.21(2).Wis.Adm.Code,submi..sion of[his fortn ro[he appropriam vo�-emmen�al unit �
is rcquircd pnor m obtaining a sanitary permic.'.Votc:.4pplica�iun forms for statc-awncd POW�TS are su6mittcd[o Project Addrcss(if diRBrrnt than mailing ad ,J,o
[he Depattmen[of Safery and Profession�Servires.Personai infortnaeion you provide may be used fbr secondary
purposes in accordance wi[h tbe Pnvacy Law,s.15.04�1)(m),Stats. �p
i.Application informa0on-Please Print All Informa6on ��$S, � ��l4 q,Ye S Ll1
Property Owncr's Namc Parccl#
�„��. w. s��l� R. Me�� oio-941-zf-3yzS
Propaty Uwner's Mailing Address Property Lopation
y'_
S57 � YVlar c-e'�'s �-h2, ra����"t�
Ciry,Sta[e I Zip Code Phonc Number e
� �-e.7SY�� �( S� LJ � $�'4 .SW ��.Sec�ion ��
II.Type of Building(check all tha[apply) c Loi= T N R � E or�
�lor?FamilyDwelling-VumberofBedmoms J LO� Z- SubdivisionName _—
Bluck*
�ublic/Commercial-Descnbe Use
� ❑Ciry of
❑StateOwned-DcscnbeU�c CSMNumber � illageof�/
C5� S/76 �Z` I�Townof LTG�W4H
iII.Type of POWTS Permit:(Check either•'Nee"or°`Replacement"and other applicable on line A. Check one box on line B.Complete line C i
a licable.
A' ew S stem
� y i�eplacemen[System �; ther Modification[o Existing Sysrem(explain; �Addi[ional Pretreatment Unit(explain)
i � �
B' �f-ioldingTank ��In-Ground �+.o-Grade �Mound IndividualSireDesign OtherTypelocplain)
(conrentional)
C. ❑Rrnewal Before �Revision hanse of Plum6er ��ransfer co tiew Ov.mer 'st Previous Permit Number and Dece Lcsued
Expiration I ����N � g �g
IV.Dispersalllreatment Area and Tank Informadon:
Design Flow(epd) Desi�n Soil Application Raie(�pd/sf� Dispersal Area Required Isf) .�Dispersal.4rea Pmposed fs� System Eleva�ion
750 .�1 1 07 IOqZ �S.S'
Capnciry in Total �of Manufa<turcr ,
Tank infortnanon Gallons Gallons L'�its � ° _
,�'cwTank ExiatineTankx I y 9 - � ,.`��
i U 's, ' a
Scpn orHoldingTank �bb� � � br � we�5{r
Dosing Chambcr O �
I
V.Responsibility S[atement-i,the undersigned,assume responsibiliry for insmllatlon of the POWTS shown on the attached plans.
Plumber'sName(Pnnt) Plumbe'.Signa � MPMiPRSNumber BusinessPhon<Numbc
� ��� Sc�.u��L IS((o1Z� ?is-ssB—stoy
Plumber's Address(Strcet Ciry.Sta�e,Zip Code)
�o��v s o K.�l�ke R d S f � e s�-c
VI.C u ty/Depar[ment Use Onty
�A �' , O Disapproved ��Per.nit Fee �,Daee Issued � issuing Agen�Signature
❑OwncrGivcnRcuonforDcnial ��Y�'� �����VI"� I �'�`-'�"^"""�o-
Conditions of Approval�Reazons for Disapprovat
���GI���� ' y���i�� �� � �� D
�a���u���� APR 0 8 2024
�CS� �`� - D�11 � ios�
SAWYER COUNTYo�
AtmcM1[o compleh plans for Ihe system and submit to the Counn'onW on paper not less then B ia c i l in m s ze
ssD-6s9s�x.oziz�� NO R�FUNDS AFTER
ISSUE OF PEFiMIT
iay3o
. FAGE 1 OF
In -Ground Gravity Plan y
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
Soil Evaluation Report & Site Map
Project Name / Description
Owner Name(s): I< e� �►� M �� l Phone: - -
OwnerAddress: l`�55 � � I'�/l�v�a4��s L.v,P�� w( Zip: S`-ffl `{'3
Project Address: � oSSZ 6J �Vl�r���-��s L �P f��-�w�r� _
(�. Lot: �_ SE 1 /4 of S� 1 /4, Section Z- L , T�J_N-R�E 0 or W �
Township: 1��w4r _ County: S4.c,� T �-
Project Parcel ID #: O l 6 a � I 2 ! 3 Y z S
Designer Information
Designer Name: �.��4h ��� U �{-� Phone: �1 ��' - S58 - � e
Designer Address: —lo�� S�oK.� l.�.ke S-�o �� (�� i.vl Zip: S`f�L�
E-mail: — �. , . . _ .�_ _ ,., �: r���:� ��.�,�o�. �_� �r�n�:
License Number: I S l (a ( Z-�
Remarks:
c.� g _ Z �
Signature: Date: '
ginal si ure required on each submitted copy.
ow�s�.: le �. ; Z �i.
I�e�:�. W.,Sh e«Y �.. lV12L� Sccw�er-Co .� (�{4.�c.�a�Tw� �
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. Septic Tank(s)Manufacturer:
IN-CROUND GRAVITY DISPERSAL AREA (.,tj��s.�r
Stepped Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down-sizing credit) SePt��Ta�kcs��o�ume�s>:
�b�� gal gal gal gal
_ I�y.--�--�_, � � �o � Effluent FllterManufacturer:
SOIL COVER � ~
min,12" Z
{ryplcaq Effluent Fllter Mociel fE: 5 �
12" `
min.trench
TYPICAL TRENCH deplh — •
CROSS SECTION VIEW ��P�f,PI) '� d
� — —_..._�---- -_-._._-- .e.. �
(No Scale) , _ • ' ' �� � ' .:°. '� Provide minimum 3 ft
r- ��yni'ai��' ; I �a separation hetween trenches.
�a a . . ..
.. . e
0
Flighest Trench -- ---- ------ Lowest Trench(as applicable)
System Elev�tions= �S,� ft; �� �� ft; ft; ft; ft
Qulck4 Standard-W
W/Elld Cap Obseroadon Plp� TYPICAL TRENCH
t ical (Show location of inlet/outlet pipe connection on plan view.) (�yn����)
� �YP � Install per manufacWror's PLAN VIEW
' Instrur.dons. �(�JO SCa�@�
- --- -- - - -- --• -- - - - -- - -
� — --- - — — - , -- ...._ ._ — �/� — -- --- — � — 1
, ,, .` �
� �� �A= 3A ft
I '., � ; � ; i1 '4� t � (lYplca�) �
�-- -- -- �- - -�- - -! - - - - -
��- - - -- -- - - - �,L - - - - -- -- _ -F; _ y
. �
�-.----- --- - a = _I �o fr �-- -- - -� rn
(typical) Quick4 Standard-W Chamber W
INSTALL PER TRENCH: (typical) o
(mfd by Inflllralor Systoms,Inc.) -�-'
--t Install pursuant to manufaclurers inslruclions. �
z- 1 Quick4 Std-W @ 20 f�EISAlchamber= S�0 ftZ
+ � Pairs of end caps @ 6 ft2 EtSA/pair= ��, ft�
= Proposed EISA per trench= S `{�° ft2 Required Infiltration Area= � Q 7 Z-ft� pistribution Method:
x Z- trenches = Proposed Total EISA = ��`��ft2 G r�u��`�
—�
PAGE�E OF�
In-ground Gravity Management Plan
IMPORTANT:
The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuarn to
requirements of SPS 382-384,Wisa 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 wlth this approved management plan.
Furthermore,all inspection and maintenance activities shall be performed by 2 registered POWTS Maintainer in
accordance with SPS 383.52(3),Wisc.Admin.Code.
Maximum Dispersal Area Operetinq Limits:
Design Flow= �S� gpd; BODS<_220 mgL''; TSS<_150 mgL-'; FOG<_30 mgL'
Insqection Checklist INSPECT EVERY 3 YEARS
o type of use
c age of system
o ruisance factors(i.e.odors,user complaints,etc.)
o mechanica 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.,distnbution/drop boxes)
c neglect or improper use(i.e.,exceeding design capacities,prohibited activities,etc.)
c extent of ponding in distribution cell prior to dosing
o dosing irregularities-if applicable(i.e.,pump re-cycling,float switch settings,etc.)
c electrical components-if applicable(i.e.,wiring,connections,switches,controls,timers,alarms,etc)
o distribution lateral or lateral onfice plugging (measure lateral distal pressure—compare to design specification)
o surface discharge of effluent or sewage back-up into structure 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 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.
c Effluent filterfs)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
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: (�P���-t �e�� Phone:
Localgovemmer.tunit: 54wticr— eo � ovii�nq Phone: Z/f 63�{-8��` _
—T
Local government unit address: I�6�� �Qi h S�- �'-�� �,�„� (p(ZIP: S�EB`�3 _
Any defective part of this system shall be repaired,replaced..or removed pursuar.t to SPS 383.51 (t),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 ihe POWTS may be used uNess approved by the department in
accordance with SPS 384,Wisc.Admin.Code.
Continqencv 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 ir-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 discontir.ued,it shall be abandoned in accordance with SPS 383.33,Wisc.Admin.Code.