HomeMy WebLinkAbout008-937-11-5106-SAN-2024-114 �� k•� Indashy Savices Division ���' �
�''ei�'`.���' 4822MedisonYmdsWay S (.c/ - �'
;.r�;Fesp - Madiwm,WI 5370i 3aoilazy PcmA Numh r(to be 6tld in 6y Co.}
_ ,�! P.O.Box 7302 �
'�'���--��=%' Mad'vwn,wI 5302 L S 1 1�(S t
���Pit���:
' Sanitary Permit Application �'°"T'�°`'"°"�°�" -�
In ai:mrOance wIth SPS 38321(2}Wis.Adm Cadc,submiscion oFUtis fam to tha aqimpriate Bovemmeotal unit
is raquvW pritt to obttining a amitery porm6.Note:Appliwtion fam for state-o�wed POW1S ere submitted to Project Addrea(if diffaent tfien mailing address)
ilie DepaAmenl of 3nfoN md Prof�sional Scrvicrs.Pesonel infamatim}rou povide may be used for sccondary
u us in accordanca with thc Ptiva Law s.]5.04 I m Stnta.
I.A plicedmInfirmation- ean tAlllato:madon S�ZD�jwldJl�,� a'' `��„'�
Property Owner's Name � Pazcel#
I'w�0 �. E �,"f-Z �SLa • 3 •//'S/ O�
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��1�3SS ��C- l2 1/ �r�-�—ge,14'.��'1'
Cny�g�� Zip Code Phwe Numba p�, ��� �
�'�Yi o�'�"/S�Btction � I
(��SS HO �/� Sy75 S
II.Type of Buftdfmg(check sll t6at apply) �K T 3 x x s w'
�1�'�a 2 Fnatily Dwcliing-Num6cr of Bedrooms � l� 3uWiviaioo Nnme
❑ �,PublirJCommen.ial-Dcscribe Use Bloak s
, -- ❑C¢3'of _
❑SWtt Owned-Descn'be Use �AS �my� ❑Ylkge of _
�v�J85 oTa.,�ae �nfpR.
� S ��
III:Type of POW15 Permit(C6ecic dther"New"or"Replaoemeut"aod other appllcable on Une A C6eck me bo:aa line B.Complete Ilne C if
a licable
4. �Netv System ❑Replacement System ❑OILa bfodi5coliav to Eiriatiog S�9am(explain) ❑Additioml Adrntmeut Unit(e�plain)
B. ❑xmams remc �in-c�o�oa ❑.ai-c� ❑n��a ��ha�i s���� ❑rnn�ryw ceq,i��
(rnnvemionel)
C.�. ❑Renewal Bofore ❑Revi�on ❑ChanBa of Plumbcr ❑Tmafer w Nn. � Previous Pmmt Number s�d Date Issued
Ezpiration ��
. is ersa ieatment Mea end Tadc ormstion:
Desig�Flow(@pd) Daign 3oi1 Application Rate(�NsQ DiRecal.4cea R«Nved<°� �*'°�Area Propoua(� syacem EIev.Y,oe
?�sv Q � � 3 Gs� s, �
��y� TMaI #of Mmufschver t.a ^ � �,�j
Taok lafametion Gellons Gallmu Ucuts "'a �� y p �
Naw TmL �*ins Tmh � «� � a•
t�
�
Septie olding Tsde vi Cj Q .. �(1 L�(7 � (a K G�y .�h
OosngC6amber . _. —_--- .
V-Re� onsib[It Statemeub I,me m�a d,�me ...aoaauh� arm�rowry�...�m.em�n.a P�..
P11u11 '6 NeRli � )� Plumber's i alun � MP/A�Il'RS NumbQ Buvneu Phm�c N�vnber
Q�U�` Jb!/!�/c's � :�C�`����CL�_c?_, ��� #�.7G335�� T/S 7�0-07/8
Plwnber's Atldnss(b'ueet.GUY,SrnW ZiP Coee) '� � �
VL Coun /De artment Uu Onl
Pe[mit Fm Ada lasued Lsumg Agent Si�a1Wtt
� ❑DisePPmved S y�?v S �`10 I��� '�',iLc�ck�e�G��
❑Owner Givrn Reuon for De`tieI �
Cohditions of ApprovallReesons for Disepproval ��J�
���� �" '� Date a-o a4_ D:�' �� `/ �=���
y ���I�L �� cneo�s soti�� �`�J MAY 1 4 2U24 �
Rcpt# I s�� y �
CST��( -G� 3 �-----
SAWYER C%i1r�TY
Attach tn camPle[e Maot for Wa md m6mK W t6r Comty only on PoDer nat Im than n me
NO REFUND3 AFTER �,;,�
s$n-G3ss(R.oz2t) ISSUE OF PER�AIT
PAGE 1 OF 4
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 4 Index & Cover Sheet Ili
Pg 2 of 4 Plot Plan ,
Pg 3 of 4 Dispersai Area Cross-Section & Plan View
Pg 4 of 4 Management Plan I
Attachments: Enclosures: I
ROWTS Application for Review II
Soil Evaluation Report & Site Map ',
Project Name ! Descrlption ,
/e �,�,i r'-{-�z II
� '
OwnerName(s): P� o+-�� ; �'�v,n�� t�ec.��'fz Phone: - - ��,
OwnerAddress: _ �. f � 3 �S Cf/ Ro� l! DSsf��� C.cl�� Zip: 5 �/�7sg ,
Project AddresS: ( S ,;Z D'�l Lc� t.c/G, 's �v� 7vc,��l t�r'.�c � /oe � SYu�'/7 ,
Govt. Lot: _�r S �cJ 1l4 of ��v cc/1/4, Section ( � , T 3�N-R �' E❑or W � '
Township: _�a� ����-<-(�iP County: S'���iyp�2
Projeci Parcel lD#_ � h g `I'3 7 r / 5 i p �, �
Designer Information
DesignerName: �/C'�vrp� Gh� �S `� Phone: 7�s- - �gU_CJlig
DesignerAddress: e'�Q7U .;�l�est S{, favpvr�c,� cUr�. Zip: Sy� TD !
E-1'Tlal�: /iv�C/� 'f6� �-v� PS � �_ �� � �"G� �� C Q ��7 "1 his space reserned for approv:il stamp. '
License Number. � �76-3 3 S y �I
Remarks:
� /j �'
Signature: - ' ' .�12C�>�� � Date: y �� I
Onginal signature required on each submitted w - ''
II
I
' a�rxeox�s�u�ae a,�ceox�e�aacras
�] SOIL EVALUATION ���'�' � SYSTEM PAGE 2 OF
SITE MAP ° '0 °0 80
PLOT PLAN
��p,►�cr wvw�: ,o� o�,��s o �
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eptic Tank(s)Manufaclurer:
IN-GROUND GRAVITY DISPERSAL AREA ��u ��� ��
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Vdume(s):
3-ft Trench (down-sizing credit) � gal gal gal s�
EHluen�Filter Marwtacturer:
CL� fN/C O
� EHluent Fflter Motlel#: l/J�� � � '� E
min.72'
(bP��)
SOIL COVER
12^
min.lrench
iy,Pa�i . • TYPICALTRENCH
'•'.� .. CROSS SECTION VIEW
I-= �^' ! � (No Scale)
(�YP��) ..�� : e.� . . .
" ' � Provide minimum 3 fl
System Elevation = 95, S ft separation between trenches.
(typical)
Qulck4 Standard-W
w/end Cap Observatlon Wpe Np�CAL TRENCH
(typlcel (Show location of inlet I outlet pipe connection on plan view.) Iryp�cap
� Install per manufxlurefs PLAN•VI EW
'"e"`�"°"s (No Scale)
i— - - - - -- - - - - ��- - - - - - - - �f- - - - - - - - - - — , 1
, A= 3.Oft
— — — — — � lHvicaq �
�-- - - - - - - - - - - - ��- - - - - - - - ��- - - - - D
B = � ` n I m
(�YP���) Quick4 Standard-W Chamber W
I�YPical) O
INSTALL PER TRENCH: (mtd ny inmtreto.s���,in�.� -1�
InstappursuanttomanufacWrefslnslruclions. �
� Quick4 Std-W @ 20 fl EISAlchamber= `3 "? D fl�
+ �_ Pairs of end caps @ 6 ft'EISAlpair= l _ �'
= Proposed EISA per trench= .�� 6 ft' Requlred Infiltretion Area= �Y-� ft' Distribution Method:
x �_ trenches = Proposed Total EISA = _�S� ft' l��edf�
PAGE40F4
i�i-yr�u�iU Graviiy ivianagem�rli rian
IMPORTANT:
The owner of this in�round gravity 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 sys[em 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 POVYTS Maintainer in
accordance with SPS 383.52 (3),Wisc.Admin. Code.
Maximum Disaersal Area Oneratinq Limits:
Design Flow= y S� gpd; BODS <_ 220 mgL''; TSS <_ 150 mgL"'; FOG 5 30 mgL''
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors (i.e. odors, user complaints, etc.)
o mechanicai malfunction (i.e., pumps, valves, switches,floats, etc.)
o material fatlgue (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 design capacities, prohibited activities, etc.)
o extent of ponding in distribution cell prior to dosing
o dasing irregularities-if applicable (i.e., pump re-cycling,float switch settings, etc.)
o electrical components-if applicable (r.e., wiring, connections, switches, controls, timers, alarms, etc.)
o distribution lateral or lateral orifice plugging (measure lateral distal pressure-compare to design specifcation)
�..�L J. L � �t �tLl.. i ...��.� l��i. ..� :��� �a�..��.. . J
u nui iacc wa�naiyc vi cuiucni vi ocwayc ua�.n-uN ww a�iva.wic xivcu
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.
o EfFluent filter(s)shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids accordina to manufacturer's soecifications. A servicina oeriod will always be oreater than 12
months.
System maintenance reports shall be submitted to the proper local government unit in accordanee with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to:
Name of individual or company: l�e h ��eq St�r v, '� �S Phone: 7i.g` ..�-3 H - J 7�0 7
,
�ocal govemment unit: -Sa t.�l Cc� , Zvh, ��� Phone: 7/S � 6jY- �.Z 8 g
Localgovemmentunitaddress: /O �l U vY��,'� Sf. / 4vc�,-� Y•�� L.t/� ZIP: 3 �1 �d `/ 3
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 unless approved by the department in
accordance with SPS 384,Wisc.Admin. Code.
Continpencv 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 in-ground dispersal component may be
abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soiis.
Svstem Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33,Wisc. Admin. Code.