HomeMy WebLinkAbout024-741-04-2204-SAN-2024-077 o C'.�j N
�"= �i IndustryServ�ce Di�ision i County �
�' _ 4S22Madis�iYatlsWay 54Lv�1<�/" Z
�, f P - Madison.R T�3705 ',�Sznitary Pcr,nii r'umber(io be fil led in by(
�,.:� . S := P.O.Rox T02 �
��;�m%'� I Madison.Wi 53707 �5��1�� S
S�1111t3Ty Perllllt/�i]pI1C'dt10I1 Scare Tmnsac[ion Number �
In accordance with SPS 3R311(2),Wis.Adm.Code,su6mission of this fortn ro the appropnatc vovemmental unit ^ -J
is required pnor to oFtaining a sanitary pertnic.Note:Application Corms for state-owned POWTS are submitted to Project Address fif different[han mailing ac J
ihe Departmen[of5a(ery and ProfessionaJ Services.Personai infortnation you provide may be used for.secondary 1
purposes in acmrdance with[he Pnvacy Law,s.15.04(I)(m),Sta�. �20(a�-I A1 LO W[r�W i,.� �
1.Applicallon Informauon-Please Print All informatlon
Property Owncr's vamc Pamcl#
r,1G.�1� R. �q��;��t h_ od.ev-- oz�G,��t- a4-zzov
Property OwmePs MaJin�Address Property Location
1�-�6�{� Loc,�er I wi h L4`c.L (Z ��`3"`
Ciry.Sta[e Zip Code �Phonc Number
*l'rt l,iXtv�c W j S`i S(`f3 j 71S_SS�-SSb�o NW�.,IJ W y,,section b�}
II.Type of Building(check all that apply) Lo�= I T x R E or
�Ior2FamilyDwelling-NumberorBedroams 3 S�bdivisionNamc
Block n
�
�ubliGCommercial-Describe Use �
�Ciry of
❑5[ateOwTed-DexcribcUsc CSMVumber iilageof
— �o��f R��Kl �a e
III.Type of POWTS Permit:(Check ei[her"Vew"or°'ReptaeemenP'and other applicable on line A.Check one bax on Iine B.Complete line C if
a licable.
A� �.'ew Sys[em i�eplacement System �[her Modifica[ion ro Fxistina System(txplain) �Additional Pretreatment Unit(explain)
B' ❑FloldingTank ,�In-Ground �1t-Grade �Mound IndividualSiieDesi�n OthrrType(explain)
(convrntional)
C. ❑Rrnewal Before !�Rrvision hange of Plumber ❑1'ransferto New Owner is[Previous Permit Number and Date Lcsued
Espiration '� —
IV.Dispersal/Treatment Area and Tank Informaoon:
Design Flow(gpd) Design Soil Application Raie(opNsf) Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation�
so .�I 6� (,qz 9 s.-�S
Capxciry in � Total q of Manufacmmr I
Tank Infortnarion Gailons �Gailon llnits i u'g -
ucu�Tanks Exixting Tankc �c` " - 'V'' h
i V v,y ' +.U a
cpnc rHoldingTank 'OQO ' We�Se h
Dosing Chambcr � �
V.Responsibility Statemen[-1,the undersigned,asmme responsbility for insmlla6on of the POWTS shown on the a[tachM plans.
Plumber's Yame(Pnnt) P r's Si� MP/MPRS�umber Business Phone Number
Q av +rar� -lq$301 �tS-�SS—Ilo-f3
Plumber's Addmss(Street,Ciry.Srate.Zip Code)
895� N S�a�c ��z� t � ,,.���� �( S�t�'�3
Vi.C u /Departmen[L'se Only
�A �a ❑Dlsapproved Pennii Fec I Da�e issued Issuin�Agen�Signature
❑Oumcr Givrn Rcason for Dcnial S f�'� y�(���'y I ��TI v"""''�
Conditions of Approval;Reasons for Disapprovai
s���?51i��
�''�� �" " �i/(�Jay °�C> _r �
�� i
'�n�����'��� �Kti� � APR 15 Z024 ���.�''
C� �� — 0 l � ,,�I d �AWYEA L���U d�Y :
- ON
AauA ro complete pla�s(or the sysrem and submit m the Counn'oNy on paper no[less tM1en 8 1/x x I l inthes in size
SSD•639s(x.ozizz) NO REFUND6 AFTER
�SSUE OF PERMIT ;�S���
FAGE 1 OF
In -Ground Gravity Plan �
Index & Cover Sheet
Component Manua/ Design References:
In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
Pg 1 of 4 - Index & Cover Sheet
Pg 2 of 4 Plot Plan
Pg 3 of 4 Dispersal Area Cross-Section & Plan View
Pg 4 of 4 Management Plan
Attachments: Enclosures:
POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description
Owner Name(s): IJcc.���-►� `I'� �e�' Phone: -tt S - SSf3 - SB �O �
Owner Address: L�-D b �f �J �owe�-- T���� �-u``� � ���!q' S`f�`�'3
�
Project Address: 1 � 6 � 0� �`���'�� � u� �"�4`' `��-'�' _
Govt. Lot: � � 1 /4 of IJ � 1 /4, Section n�-E. , T '-f( N-R d 1 E ❑ or W �
Township: � oc�� � ���-�- _ County: S4 � � �--
Project Parcel ID #: D� —Z'`�� — e `� — Z-z ��
Designer Information
Designer Name: R.ti ce.v� S �ra,�n.� Phone: Z� S - SS$ - l b � 3
Designer Address: �R Sr r.� �" IZ� Z`7 I��rW� (-vl Z�P� S�`��
E-mail: . .... �_,:,�� �,�� :�.: ._,: <:,,�,-�;�:�., sc�:m:
License Number: �1 �i 8 --3 O 1
Remarks:
signature: Date: ' CJ� 'Z`�
Original s ature required on each submitted copy.
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IN-GROUND GRAVITY DISPERSAL AREA . SepticTank(s)Manufaclurer:
1,���ser
Stepped Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down-sizing credit) - Sep"°Tankcs��°�ume�s':
IOUO gal gal gal gal
( � t o(y�O � Effluent Fllter Manufaclurer:
SOIL COVER �
min.12„
(ryplcaq [flluent FUter Mocief#: sZ'S
12" �
min.lrench
TYPICAL TRENCH ��P�n — �
CROSS SECTION V�EW �"��`a'� �. � �
. _" —.....___'""_'. _. .4., �
(No Scale) ,_ �� � '� �, '. , .'d. °� Provide minimum 3 fl
r 34" �" .-=i a separation between trenches.
(�Yplcal) ., ., .
n . °•' ' e
a
Highest Trench --- Lowest Trench(as applicable)
System Elevations= �5.,S ft, '�t S,-1 s ft; ft; ft; ft
Qulck4 5tandard-W
W/Efld Cap O�servatlon Plpe TYPICAL TRENCI-I
t Iral (Show location of inlet!outlet pipe connection on plan view.) (�yM�a�)
�yp ' � Install por maoulacturors PLAN VIEW
' Instructlons. �NO SCa�e�
�- -- -- --,- - _� __ _- -- - - �jL - - --- - - - - �j�-- - - -- - - - --- - .- -�
I , ,:,�� .� >: `` . i• .` : � �A= 3.O ft
I._._
i, ,
� (IYplcal) �
- - -- - - --- - - - -��- - - - - - - - �f-- - - - - -- -=-'- -- -- --= —� �
B = 701 fl `) '�
m
- (typlcal) -Quick4 Standard-W Chamber W
INSTALL PER TRENCH: . (typical) 0
(mfd by Inflltrator Systems,Inc.) —�-�
O Inslall pursua�►lo manufacfurer's inslrucllons. �
�, Quick4 Std-W @ 20 ft�EISA/chamber= 3.y ft2
+ � Pairs of end caps @ 6 ft2 EISA/pair= � ftZ
= Proposed EISA per trench= 3��O ftZ Required Infiltration Area= 6� ft` Dislribution Method:
x Z" trenches = Proposed Total EISA = lo��- tt2 q r�,��'�y
---�
. ��
PAGE �OF�
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
requiremen:s 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),Wisa Admin.Code.
Maximum Dispersal Area Operatinq Limits:
Design Flow= U SO gpd; BODS<_220 mgL-'; TSS<_150 mgL''; FOG<_30 mgL'
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
c nuisance factors(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.,distnbution/drop boxes)
o neglect or improper use(i.e.,exceeding desigr capacities,prohibited activities,eta)
o extent of punding 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 onfice plugging (measure lateral distal pressure—compare to design specification)
o surface discharge of effluent or sewage back-up into sVucture served
Maintenance Checklist MAINTAIN EVERY 3 YEARS(or when necessary)
„ Seqtic 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 ordinar.ce. Disposal of cortents shall be pursuant to NR?13,Wisc.Admin.Code.
o Effluent fiker(s)shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufacturer's specifications. A seroicing period will always be greater than?2
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 indlvldual or company: 1J c�?� `�o�2�r— Phone: 1�s S SO—ss�0�
� —
Local government unit ��-�� CJ �FJh�hc Phone: 7/S 6 34-8L8o _
Local government unitaddress: �O(pl(7 ��„S�"�td� �'a.yWa�� Lr�� ZIP: r7�{Sl� _
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.Admia Code.
No product for chemical or physical restoratior of ihe POWTS may be used unless 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 agercy for review and approval. A failed in-ground dispersal component may be
abandened and replaced by a code-complyinc dispersal component in a pre-determined area of suitable soils.
Svstem Abandonment
if use of this POWTS is discontinued,it shall be abardoned in accordance with SPS 383.33,Wisc.Admin.Code.