HomeMy WebLinkAbout026-939-27-5219-SAN-2022-074 L�'
����"."'"�'�r� Industry Services Division ��»tY �
� 4822 Madison Yazds Way s� (,�.;,� t �
�� ` Madison,WI 53705 Sanitary PermitNumber(to be filled in by Co.)
' � P.O.Box 7302 _ k
, .� �
��,;�A���' Madison,WI 53707 �C� ��'; �` a �
Sanitary Permit Application StateTransactionNumber �
�
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit �
is required prior to obtaining a sanitary permit.Note:Application forms for state-0wned POWTS aze submitted to Project Address(if different than mailing addre<
the Department of Safety and Professional Services.Personal information you provide may be used for secon S�C�U N Nc�✓�—�a��,� ��„ �
purposes in accordance with the Privacy Law,s.15.04(1)(m),Stats. �
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Property Owner's Name Parcel#
� !�E? � �U�S � � �oZ L�}3�2 `� 1�(
Property Owner's Mailing Address Property Location
�L� Ci � L/'1J Gbyt.���
City,State Zip Code Phone Number
�'�c.e_/� 1►' l�e.'• � .Z �S"� i N o���Section 2 7
�1 or 2 Family Dwelling—Number ofBedrooms� l � �J '�' Lot# � T �1 N R � E o
h� �� Subdivision Name
Block#
�ublic/Commercial—Describe Use �
❑City of
�State Owned—Describe Use CSM Number illage of
�3�1alo �31`f`� �'o.�of ��o��.,d L��.k�
:�.�'a, n��'��a ��%,__�.� ,�.�,�.�+�.�r ��'�'�;� a-�. �. � '�z � � x>;
��: � _ � � �- '� .. ..._ F , ,w�e;
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«�.- . � . � � �z,,.. rr .o _.�:� � �. �� .�r _ . . t.
`�' �1ew System �teplacement System ❑Other Modification to Eacisting System(explain) ❑Additional Pretreatment Unit(explain)
L�1J
B' ❑EIolding Tank �In-Crround �4t-Grade �Mound Individual Site Design Other Type(explain)
conventional)
C. ❑Renewal Before �Revision ange of Plumber �I'ransfer to New Owner ist Previous Permit Number and Date Issued
Expiration a`�" (tOd � /a��iq8
F _�>� �.: .,._,.. -, .
.. _ � ...._,,... , � � � � � �� .�_;� r�«a:°�,k� ?��'� ,?...x::+i"s.� � �
_ , .. � . �.e..��_ . .. �!;
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation
�v c� � � �/.�,� ��s:2. 9.S; l.�
Capacity in Total #of Manufacturer ,
Taak Information C*dltons Gallons Units � ` � '$ _
New Tanks Exishing Tanks � Q M " « � � �
U 'v� � v� fi C7 0,
septic or xolaing'Iank �j E"I Ci �/U i l-J i�(�`
Dosing chamba Jr L v �p � �
"� �
x x'�Se — .t: � �6� 1 �ry xr .:+�r ,� '�ti�. �'�`�.�:�t
aLowa ogl�ie��� i��l�i��v'��r�r��'���..,r 'y�a.,_,,,_r ,,.��
Plumber's Name� � � Plu ber's Signature MP/Ml'RS Number Business Phone Number
Jerry Ru��xcavating, LLC ��, ,� �i�� ���.�� �� 7;5- y���2,� d����
Pl Stone Lake� I' 4g�'6P c��>
_�l�.�f'* � -`*".:� i-sak,.E� '� �t ,:F,�"�r��Wy� ';,,, 7i�s.f-.. A� q.a ��.w-,r.rx a^_.. ..r,�i a a , �,=
,,>w :az �s ..-u:-�.�t u m� ar a�.u+r���^ ,.u.a f'.,. ..Ydh�k �. .y;<�.. .:�^ s x'.�s 3... a'x'�,,...
�. � °f , � Permit Fee �Date Issued Issuing Agent Si�nature
A � e�� ❑Disapproved a � ,
� �,/ . . n
❑Owner Given Reason for Denial l�`�° 7 i`i �,� "i t y'j�,` �;,'��:-�'�'�-�„,;;:r
Conditions pf�pprQ�j�teasons for Disapproval � a �y
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i�iSTRATiO�I
Attach to rnmplete plane for the syatem and submit to the Coanty only ou paper not less t6an 8 1/1:11 inc6es in size
NO RE�UNDS AFTER
SBD-6398(R.02/22) ISSUE OF PERMI7
PAGE 1 OF 4
In-Ground Gravity P�an
int�x & Cover Shee#
Camponerrt Man�al Desigr�R�noes:
Ve�t Z.O,SBD-1070�P(N.01/01,R. 10/12). , .
Pg 1 of 4 . index � Cover Sheet
Pg 2 0#4 Plot Plan
Pg 3 of 4 Dispersai Area Cross-Sec�ion 8� Pian View
Py 4 of 4 Management Pian
� �a� .. Q N r"1P -�'^� ;�•,'T�
��T1�!' •
. .
POWTS ' for Revte�w
Soi� Evatuation R 8� Si�e
Pr+oject t�fame/Desc�ip�iort
Owr�t�ans(s): Rvb��� ��t���� -t,l� Ptron�:
Owr»r I�dd�: �0 3 t� l2�.�5 L•v Zlp: �-�i 5�
Proj�Ct l�►ddt+Nf: '�l�/v�� 1-(�t.Y, - Nr�L(y �;<
t3o�v�E.o� 1/4 o�f 1/4, Section Z 7 . T 3� N-R � E Q or W 0
To�: S�N� 1-..�k� County: `�G�.-� y e-�-
Pt�o�ct Parcei 1D�: � z L i 3`i �.�7.�Z t`l
Deslgner In�brntatlon
��; Jerry Ruid Ex,cavating, LLC Phon�: 7iS -�Z- ��t d-�
D�si�r�d�h+�ss; Stone Lake,w� sa.B�g Ztp:
E�: _, t-��d Q G G�,�7Tv e y`j'G(. ti LT This epaoe rc�vrd far approvsl e�mmp.
UqM!Ntin�: �.- �( �,�c. 6�
Itor�iCs:
S�Ana��uro: �-t� �--�, D�Ite: �'��' �.2
an ��muea oop�►.
,
CFIECK BOX AS APPLIGIBIE CIIECK 90X I�S APPUGBLE.
� SOIL EVALUATION �'��'"=40' Q SYSTEM PAGE 2 OF
SITE MAP � � � � PL4T PLAN
PROJECT NAME ��� DESIGN FLOW: 30d Gpp
�o�.S y�.(,� Attach design flow calculattona for commerdal plans.
PRo.IECT ADDREss: S�1C� N Qv�— t�o ��Y �C'. Pipe Matarial/ASTM Standard(Tablea 384.3D3 8�384.30�b)
1 CJ U� C7 N santtery sewer. �/�� ``,c�` �'O !��J L
BM�d: � siN aev�wn: FT Force Main: Z " S�F► t� U c--
(� y��
BMDaacdptbr� QG'�-t'�-o��-, Ct4 �[!� CrJ�c
Slops Gradiar� ���e�,ey IMPORTANT:
ot Tes�edllrax(�) w��eyr�d(�tappitc�ds): Q �d�no an.�,aw Show ground eleveUon oonfiours et euitabie ir�tarvals.
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s<�s�e,� �',s�� -��.(: 2
Jerry Ruid Excavating, LLC l.�V.� �35�2�'
. W208 County HWY A �d�S� c.�3-�
Stone Lake, WI 54876 �v�� �`_
c.si/�' - 2�z..�� 2 P� " `��, �
' ��i l 5 � ��1 �v i"�{ ,I�� " \ ' �C'l��
( ' `/ u � ��
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I R�ept Pstop 1
IN-GROUND GRAVITY DISPERSAL AREA w���-�
Uniform Elevation Trenches with Quick4 Standard-W Chambers s�„�T,�c���c.x
3-ft Trench (down-sizing credit) �:4� �, ;��, �, �,
����
i—",4 z-r��,�r_ L-��-- .
�nus�x Flia►Moar� �-��
mn.t?
301L COVER (�p�)
mo-i�tanN
ca�� • • TYPICAL TRENCH
� ''':;•: CROSS SECTION VIEW
�"—�� . . . (No Scale)
, ' ..•�. ;'
• ' •' Provide mfnimum 3 R
System Elevation G�r U tt separalbn beMAan tranc#�es.
(hP��q
n�sr��b-w
w/End Cap �Show location of inlet/outlet pipe cannecti«i on plan view.) ��° TYPICAL TRENCH
(�'� ��vw m•++�+•h PLAN VIEW
�`'�`' (No Scale)
� ----�j�-------�f--- �A-c�o '�
----��--------��--- �
B= �_ � --I rn
c��) �u�aca stanaera-w c�ember W
INSTALL PER TRENCH: ��� �
c��'����.� 'n
a�1 v�•M m rr�f�Aae�,nh heanWlans.
��Quia�a std-w�2o t�eisa�m�r= 22c5 � A
+ � Pa��s o�e�a���s�Eisa���= _,�n�
�Propoaed EISA per trenc�= ZZ� g= Required Infiltredon Area= ��� ft Distribution M8111od:
x � trenches=Proposed Total EISA= y�z tt� I�v;� G�c����' y
�
1
�. Si
� PAGE 5 OF 6
SEPTfC / PUMP TANK SPECIFICATIONS .
4��� (No Scale}
�o��
�.�,m�c�v.�,
12 Mn.�1!�boN SPS 318 and I�C 300
Fib1�F+�d Flood Bw�tlon � E�nd en�nNoi�Ar►a�n�a�wty.
� �� Junotlon BCot �����
IMPORT/11YT: �� w�e,wm,�np t�b.a llm.dra
(A�P�4
Ar�ct�or�C(s)at neoee�y cc"a�x a■�►.a z.o�.t�a.
purauant�O SPS 983�43(8K9)
EM�bfN�d Ftood El�tlan
t�rv�I
. ���� , IG�
FlN�h.d t�ads : �Oic oboo�v,.at
CAPACITIES t l�� • t��.
� 9� e: ' , y, t�rr�)
k ',• • �
�P�M) Vdume(9si)
A 2Gs(0.�3 31� *� wap �o�a.�,e.�a,
F�o+. �nwa.a qa.a tt a,m
B 2.0 Z�3".��� � " �i
[C] c��3 -� s � � �
o � �g.d . ��P B _�,
� � PUMP-0FF
*Pump Tank Liquid L.e�vei = in t , � —� ELEVATiON= � � � it
�
° �,,,�,.,, IN81DE BOTfOM
Fores Main Dtameter= � tn �
�
ELEVATION = �� ft
For+cs Maln Lsngth = sOaO ft �'��•a e.aar,a�e.r,.dr,r.�
Forae Main Void Volume= So Qal Verticel Head = �eC� ft
+ Min.Supply Hesd = 2°S ft
IGl � � vo � = 8 a.lo �aVdose
+ FM Fric�on Loss = M� C� ft
(9c tiodi i�l void voku►�s�,TDv e o.2x de�iqn tbw)
+(ta�cs meh d�nbeedc vdims) + Fittin fl Loss' = � ft
"`(min.suppryr hwd x 0.3)
MIN. PUMP DISCHARC3E RATE= Z� gpm =TOTAL DYNAMIC HEAD = ���° � ft
PUMP TANK . SEPTIC TANK(S�:
Volume= ��� gal Total Volume= �;�(c� �el
Martufac6urer. w � e-S�(' Manufacturer(s): c�.�•e S�c�
Pump Manuiscturer: Z o�l/-e o-
tnatatt accr o�ved eRluerrt fi1tBr at the sec�ic tanlc out�t
Pump Model: `�� �,�,���,,,,,.� )mmediatielY unstr�am afi tt�e numn tanlc lnlet
CorttrdalAtartn Martu�fac�urer: SS� �o►�,b�s Fifter Manuiadurer: �-��G�-t,r rr�,
° � Coratr�lAlarm Nbdei• J,��K �I�er`7- 1 �1/8
� � Filter Model: L�
Fioet s�c�as con�air�it�m��ry ats ot�Ftibi�d.
.. . .
PAGE40F4
In-ground Gravity Management Plan
IMPORTANT:
The owner of this in-ground gravity system shail be responsibie for its perpetual operation and mairrtenance 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 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),Wisc. Admin. Code.
Maximum Disnersal Area Operatin4 Llmits:
Design Flow- 3�c� gpd; BODS 5 220 mgL''; TSS <_150 mgL''; FOG 5 30 mgL''
Insaection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors (i.e. odors, user complaints, efc.)
o mechanical malfuncfion (i.e., pumps,valves, switches,floats, etc.)
o material fatigue (i.e., leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treatmerrt tank(s) and any distribution appurtenance(s) (i.e., distribution/drop boxes)
o neglect or improper use(i.e., ex�ing design capacities, prohibited activities, etc.)
o exter�t of ponding in distribuution 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 orifice plugging (measure lateral distal pressure—compare to design spec'rfication)
o surface discharge of effluent or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o �ptic 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)exc�eds 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 filterls)shall be inspected every 3 years and shall be cfeaned when necessary to remove any
accumulated solids according to manufacturer's spec'rfications. A servicing period will 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 �e-t`f'� ��.d Phone: �/S -`t�t�' 2`�v�
Local govemment unit: S L � Phone: ��5� � �`{� �3,��
Local govemment unit address: %OC:I U (Y14.�.v s�� `���i-z-`� ����i �u� ZIP: � `�� `t 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.
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 in-ground dispersal component may be
abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils.
Svstem Abandonmerrt
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33,Wisc. Admin. Code.
1 Reset Page
� ~ HEA� CAPACIN CURVE 3 7�8 6 1�4
� `` MODEL "98"
30 4 S/8 -+�{
�
e
23 e I I
� 3 5/8
= 5 20
52 �
� 15 + +
0 4 � I
J
o �0 4 3/t6
A
2
s
o ,
1 1/2-11 1/2 NPT �
U.S. CALLONS 10 20 30 40 50 60 70 80
LITERS 0 60 160 240
FLOW PER MINU7E
MODEL 98 60 CYCLE
Feet Collone Metere Liten
�s 72 1.3 277
+o e� s.� 2a+
15 �S �.6 170
20 t3 6J 9! � � �2
leeM YaNr. 2T
009971 �
� 4 3/16
. �
, • SK1102
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Electrfcal attemators,for duplex systems,are available and • Variable level float sw(tches are available for controlling single
supplied with an alarm. and three phase systems.
• Mechanical altemators,for dupiex systems,are available • Double piggyback variable level float switches are avaiiable
with or without alarm switches. for variable level�long cycle controls.
I
SELECTION GUIDE
� 1. Integrel floet operated 2 pole mechanicel switch,no external control required.
Standard all models-Welght 39 Ibs. - /:H.P. 2. Single piggyback varlebie level floet awitch or double piggybeck varlable level,
98 Serlea Control 3electlon floet awitCh.Rafer to FM0477.
Model Voite•Ph Mode Am a Simplex Dv Iex 3. Machanical attemetor 10-0072 or 10-0075.
M96 115 1 Auto 9.4 1 or 1!4 7 — 4. See FM0712,for correct moCel of Electrical Altemator.
N98 715 1 Non 9.4 2 or 2�8 3 or 4�5 5. Control switch 10-0225 uaed as a control activator,specify dupiex(3)or(4)
floet aystam.
D98 230 1 Auto 4.T 1 or 1 6 7 — 8, Four(4)hole J-Pak;Junctlon box,for waterttght connectton or wired-In
E98 230 1 Non 4.7 2 or 2�6 3 or 4 b 5 eimplex or dupiex operatton,l0-0002.
7.Two(2)hole J-Pak,for watertight connectfon or splice.
CAUTION
For Intortnelion on additional Zoetler products reterto cateiog on Plggyback Variable Level Svltchea, Ail Instaliation of controls,protectfon devices and wlring shouid be done by a qualifizd
FM0417;EIectrlcalAttemetor,FM0486;MechenlcalAltemetor,FM0495;Sump/SewageBaslm,FM0487; Ilceneedalectriclan.Atlelectricalandsafetycodesshouldbefollowedincludingthemost
Sfngle Phase Slmp�ex PumpConVol,FM1598;Nartn Systems,FM0732, reeent Natlonal Electric Code(NEC)and the Occupatlonat Safety and Health Act(OSHA�.
RESERVE POWERED DESIGN
For unusuai conditions a reserve safety factor is engineered into the design of every Zoelier pump.
MA/L T0:P.O.BOX 16347
, �'7O � r Loulsvllle,KY 40256-0347 Manufacturersol..
LSFfIP T0:3649 Cane Run Road
a � Lovisvllla,KY 50211•1961 �+
PU/i�lP !O. (502J 778-2731•1(800)928-PUMP QUA��TY PUMAS,,�/NCF �9����
hnp://www.zoeller.com FAX(502)774•3624
� "T �`.: PRIVATE ONSITE WASTE TREATMENT county
j�je`i.i_ \�� SYSTEMS
�
'�(�SPs ��`� ( POWTS) Sawyer
"'Fs�'�=��/ INSPECTION REPORT sanitary Permit rvo:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION ��_��(./
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(i)(m)] �
Permit Holder's Name: ❑City ❑ Village � Town of: State Plan Transaction ID#:
�d�"V� �rS �� �C'i �
Insp BM Elev: BM Description: Parcei Tax No:
fD��c`� � �a v� s i�lt� o� -Q3`� -�7� .s'�t
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic ,,u�� _ � Benchmark �q��p�
Dosing ^ ��„bp �p
Aeration Bidg. Sewer q�,gs'
Holding St/Ht Inlet gp,5- '
TANK SETBACK INFORMATION St I Ht Outlet qo,�$ '
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIRINTAKE
Septic �-�� �-�p� 6 � t6� NA Dt Bottom �(�,6��
Dosing �• y « � NA Installation
Contour
Aeration NA Header/Man. �,�,�
Holding Dist. Pipe
PUMP 151PHON INFORMATION Infiltrative
Surface 9�o `
Manufacturer ��`�� Demand Final Grade
Model Number GPM N� l, �. 9�,5�
TDH�p Lift Friction Loss Sys Head TDH Ft
Forcemain L � � Dia �" Dist.To Well
DISPERSAL CELL INFORM TION
DIMENSIONS �N L L(y #of Cells Type of System Distribution Media Manufacturer:
� Conv ❑ Aggregate �'
SETBACK P I L Bldg Well OHWM of Nav � IGP r�Chamber �'' '
INFORMATION Waters � AG ❑ EZFIow Model Number:
CELL TO � t �t-,Lr -t'(Oc ��� _❑ Mound o Other Q��
DISTRIBUTION SYSTEM x Pressure Systems on�y
Header I Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes
Length Dia Length Dia Spac _ � Spacing ❑Yes ❑ No
SOIL COVER
fDepth Over Depth Over Depth of Seeded/Sodded Mulched
Cell Center Cell Edges I Topsoil _ � ❑Yes ❑ No � ❑Yes ❑ No
COMMENTS: (include code discrepancies, persons present,etc.)
���Il�.�l � ( ����-�
Plan revision required?❑Yes❑ No � �� �3 � - � _ J b�'j � �(o �
L
Use other side for atlditional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3I01)
AOOITIONAL COMMENTS AN� SKETCH
SANITAAY PEAMIT Nl1M8ER: a'Z��Z S�
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