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PAGE 1 OF _3
In-Ground Gravity Plan
Index & Cover Sheet
Component Manual Design References:
In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
Pg 1 of 3 Index & Cover Sheet
Pg 2 of 3 Plot Plan
Pg 3 of 3 Management Plan
Attachments: Enclosures:
POWTS Application for Review
Soii Evaluation Report & Site Map
Project Name / Description
OwnerName(s): C��eS�,- �-��f('�� KrT�' ��� Phone: - -_
Owner Address: 1��lll I��w;s �' l,�hxzQS+�c,�,.�L Zip: �
ProjectAddress: 56�10_ 4> :Sc��uac �; (�
Govt. Lot: _� 1/4 of 1/4, Section_,�, T 3 1 N-R S E 0 or W �
Township: �����.?l County: S4 �Ye ''
Project Parcel ID#: O 3� S3�/ b� S� �u _
Designer Information
Designer Name: � � S �o�'"��_S�a1 Phone:�s -�- �` �
Designer Address: SQ FS�1- N / �Dr�t(�� hx �il�� Zip: S �`ILo _
E-maiL• c�c�6l��n0l��San(/c e l;ve� �c�� _
License Number: c�� f� �i«
Remarks:
� � /
Signature: �`� � Date: `S� � �
Original signa uired on each mitted wPY�
CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE.
� SOIL EVALUATION �'�� '" -40' (� SYSTEM PAGE 2 OF`3
SITE MAP � � � � PLOT PLAN
PROJECT NAME: Z DESIGN FLOW: L(v U ��
(1 D ft grid) 10
���� �K -1-�� �eP��,�����-� Ariach design flow calculations for commercial plans.
PROJECT ADDRESS: S���O -� 'J`���w S�� N�C Pipe Material /ASTM Standard (Tables 384.303 8 384.30-5)
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BM S�rmbol: � BM Elevation: �G�Ll.J � FT
� ' I Foroe Main: /
BM Descriptlai: �0 t� �1� C�l`
indicate rwrm by IMPORTANT:
Slope Gradient(%) ..�-- VYe��S�rmbol �if apppcaple�; 0 arawtr,9 an arrow Show ground elevation contours at suitable intervals.
of Tested Area: on the approprite�ine.
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PAGE3 OF��
in-ground Gravity Management Plan
IMPORTANT:
The owner of this in-ground grav'ity system shall be responsible for its perpetual operation and maintenance pursuant to
requirements 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 mai�tained in accordance with this approved management plan.
Furthermore,all inspection and maintenance activities shall be performed by a registered POVYTS Maintainer in
accordance with SPS 383.52(3),Wisc.Admin.Code.
Maximum Dispersal Area Ooeratinq Limits:
Design Flow= �ro gpd; BODS 5 220 mgL-'; TSS<_150 mgL''; FOG<_30 mgL''
Insaectlon Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o 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 treatrnent tank(s)and any distribution appurtenance(s)(i.e.,distribution/drop boxes)
o neglect or improper use(i.e.,exceeding design capacities,prohibited activities,etc.)
o extent 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,conVols,timers,alarms,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 structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS(or when necessary)
o Seotic and dose tank(sl shall be pumped by a cert�ed septage servicing operator licensed u�der s.28�.48�Nis.
Stats.when the volume of solids in the tank(s)exceeds one-third(1/3)the liquid votume of the tank(s)or
as required by local ordinance, Disposal of contents shall be pursuant to NR 113,Wisc.Admin.Code.
o Effluent fliteris)shall be inspected every 3 years and shall be deaned when necessary to remove any
accumulated solids according to manu(acturer's spec�cations. A serviang period will always be greater than 12
months.
System maintenance reports shall be submitted to the proper locai government unit in accordance with
SPS 383.55�sc.Admin.Code. Report any component failure or mafFunction to:
Name of individual or company: hJ(�n / nJ/hAS)/� � �S � Phone: �lS-=��o{���
� .
Local govemment unit�L�Pr n��T/ �f1 i/�s Phone: 7I S��v J�I'Sj��Sk_.
�
Local govemment unit address: I a� �n ��:���'� �L '�P N�( ��l�,`� Z�P: �Sy f'y� —
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.Admin.Code.
No product for chemical or physical restoration of the POWTS may be used untess approved by the department in
accordance with SPS 384,Wisc.Admin.Code.
Continaencv Plan
in the event that any failed treatment component of this POWTS cannot be repaired,it shall be replaced pursuant to
a pian submitted to the appropriate agency for review and approval. A failed in-ground dispersal wmponent may be
abandoned and replaced by a code-complying dispersal component in a pretietermined area of suitable soils.
Svstem Abandonment
If use of this POWTS is discontinued,it shal►be abandoned in accordance with SPS 383.33,Wisc.Admin.Code.