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HomeMy WebLinkAbout024-541-30-5516-SAN-2022-094 ��� ��'�">;��_ Industry Services Division County \ , _ (' 4822 Madison Yards Way SGW G C' � ; , : - b Madison,WI 53705 Sanitary Permit Number(to bc filled in by Co.) - �' '_ . � �� P.O.Box 7162 ' ( � _ Madison,WI 53707-7162 � �� (�� '-{ � Sanitary Permit Application State Transaction Number ► In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit � is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) ,sj the Departrnent of Safery and Professional Services.Personal information you provide may be used for secondary � purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. � (��'3$ � ���o ����� ��,1 I.Application Information-Please Print All Information Property Owner's Name ',' Parcel# Tc.�n.e. �' + c-b �-b•. P� 13e�z M v 1� O�'-1 -S�l �' 30 S S) (p Property Owner's Mailing Address Property Location ��o {r v:h Govt.Lot.__�� City,Sta[e Z.ip Code Phone Number 5 / ��v 1 � �N S��Oa ���1l�Section c3� •c II.Type of Building(check all that apply) Lot# T y�N R__��E-or �1 or 2 Family Dwelling-Number ofBedrooms � 3 Subdivision Name Block# �^ ❑Public/Commercial-Describe Use �. ❑City of ❑State Owned-Describe Use CSM Number ❑Village of CS t1 k�. ,4 7 g ^�-�-own of I�a.�n� La,k Q _ ���•7 . a`1�-/ II1.Type of POWTS Permit:(Check either"New"or"ReplacemenY'and other applicable on line A. Check one box on line B.Complete line C if a licable. 'a �New S stem � Re lacement S stem Other Modification to Existin S stem ex lain y p y g y ( p ) � Addirional Pretreatment Unit(explain) B' � Holdin Tank �pr � Mound 0 Individual Site Design yp p ) g +o,,In-Ground � At-Grade Other T e(ex lain (conventional) C• � Renewal Before Revision � Change of Plumber � Transfer to New Owner �st Previous Permit Number and Date Issued Expiration 1V.Dispersal/Treatment Area and Tank Information: � p„�; K y P(�,3 C,i►wn+6�i-5 w / 01 SC o�F'�r►d Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(st) System Elevation o� a .� ya9 ysa � 9�. oa � � Capacity in Total #of Manufacturer � Tank Information Gallons Gallons Units � � �o � � New Tanks Existing Tanks ` o � � Y � � � ��"14 O a U rn ti v� w c7 a. Septic or Holding Tank y� �_ yo , DosingChamber `ry�V �-- 56� �qn eh�� ,�v V.Responsibility Statement- l,the undersigned,assume responsibility for in tallaHon of the POWTS shown on the attached plans. Plumber's Name(Print) Plumbe ' . � ature MP/MYRS Number Business Phone Number • s c1< a3o �3 Co 7�s-Co3y-!lo^/9 Plumber s Address(Street,City,State,Zip Code) I c� a a a s Nw c 3 l�G w a('d, c�s s y a �3 VI.C u tylDepartment Use Only �A e ❑Disapproved Permit Fee Date Issued " Issuing Agent Signature � ❑Owner Given Reason for Denial $��'•D � I� 1�� �i�--�.ln����-� Conditions of Approval/Reasons for Disapproval � . o � ������ ��� ' � Cs1 �� - �63 � ��� Q J U� 0 3 2022 �.� SAWYEf� ;_;r�-----._... Zt�NINGFC;N�i�;:�: _,r•� Attach to complete plans for the system and submit to the County only on paper oot less t6an 8 1/2 x 11 inches in size SBD-6398(R.03/21) NO REFUNDS AFTER ISSUE OF PERM17 � PAGE 1 OF 5 In-Ground Dosed-Gravity Plan � Index & Cover Sheet Component Manual Design References: Version 2.0, SBD-10705-P (N.01/01, R. 10/12),,, Pg 1 of 5 Index & Cover Sheet Pg 2 of 5 Plot Plan Pg 3 of 5 Dispersal Area Cross-Section & Plan View Pg 4 of 5 Pump Tank Specifications Pg 5 of 5 Management Plan Attachments: Enclosures: Pump Curve POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Betz Mullen - Pine Point Rd Owner Name(s): James T & Barbara A Betz Mullen Phone: - - Owner Address: 268 Irvine Ave ; Saint Paul, MN Z�P: 55102 Project Address: 10438N Pine Point Rd Govt. Lot: 5 _1/4 of 1/4, Section 30 , T 41 N-R 05 E ❑or W ✓� Township: Round Lake County: Sawyer Project Parcel ID#: 024-541-30 5516 Designer Information Designer Name: Ray Visocky Phone: 715 _634 _1679 Designer Address: 16222S Hwy 63 ; Hayward, WI Z�P; 54843 E-mail: visockYPh@9mail.com �,�♦ ���:; ,� t„�.,; , :,,_, ,�:,�,. License Number: 230236 Remarks: Signature: Date: S /� Zu ginal signature required each submitted copy. : ���U� � �.n � c7� er•. L Q a,.� : SuwteST-� �.r6�.r�,A�. ��'Z �v ��e� S�.w�er- Co.� 6Z-���.� La�� `T`�s� z�,g �r���...e, i4��e. t'tr.�: oZ.`{--S�t1-30 -- SS�� 5-�- i��v 1 � Nt r.� SS�o Z �r{- �ov L�- S S`3 O T �-(( N (L 0.�C� 6!Z. - 6 0 0 - c o�4 9 -L.o-�' 3 CS t�t ��z�y jt- f y-�]g 5.-��� Iti`f3$N t�►ne P-F ��. f?,�Y r � o°� Lo-�3 ± l.s�t�.� � � � s'c�.(� 1''r �a � � p` to' 20` 30' V a _ ga��� BF'�LDQ� COrher o-F GOnC��"�'t ct�rov� SN�oo' sE corv�e�c— , � tv (. 49.�, � 2, S�.R' � _ . �.� 3- �O�'S � - -- _ _ o F....R(�. 3 :Z So:�5� S�s�. e�eJ. 4-1` _ � - --._ _ - --_ � Ccc•�C _ R(o` —.. 9-l.S�� __ .. _ _ _. �° �s-�- 5.'�. �a __ _ _ -- -_.. ` t-a"a.rc ��cn IVTM D 1�85 -� Ce v.�2.5 pv w. �7 - - � --- _ _ P-� . � �Z . �- CT —� - � --__ __ �` y"ArGSawYOhtTriF841 _ ` __ _ ______ __ --5�e�..�t� —SQ��� ._..._. _ _ _. . _. __.. � �Ta.�a� _ __u .._J __ _...___.. _ ��.ba�tl __ GT+� 8yU/S"Oogal• �cti�`�o.,b cw►G�+e Cew+b�rre.�+� d�sa�� ,Sepfi:c/���(� i�r.nK r.�c►de b� W�'tscr (,o++c-�cl[ t b y �.s f L;f�}�-r,t 4T'/E r i I�c r an d Zo e.)le e ON C I��ar..p_ Lo9 j�A = Abg�l.u., AK4 cy,s�Sf.'ng � �wo ca 115� S�7aace ' 3 FF �p.►r3� ca+.�a�n�� a �-e�41 o�r �. Qv:e►a y i�l�t CNew.6tr`S Syb1e�. ��evo,�.or+ : 9'�.U O F�' Y l _ 7 � � Sz' �� �.�. --� _ _. .___. ��onse L.alr.e-�- � ���e c� o� �. IN-GROUND DOSED-GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard-W Chambers 3-ft Trench (down-sizing credit) � min.12� �rp�CAL TRENCH SOIL COVER (typlcai) ,z.. CROSS SECTION VIEW min.Vench (No Scale) depth • (�YPical) �'. • ' �.. • • •. ' . .d �a I--- a4� . '.' . . �rypicai} �:, � � � ., � � Provide minimum 3 ft + a ' separation between trenches. System Elevation = 97•00 � (typical) Quick4 Standard-W w/End Cap Observatbn Pipe (typical) (Show location of inlet/outlet pipe connection on plan view.) �typ���� TYPICAL TRENCH Install per manufacturer's Instrucnons. P�N �/�EW �-- - - - - - - - - - - �j�- - - - - - - - �� - - - - - - - - - — � (NoScale) �' i , :.� ; � A= 3.Oft r , (tYPical) �- - - - - - - - - - - - ��- - - - - - - - �j�- - - - - - - - - - � � �' = g 47 ft � � {rypical) Quick4 Standard-W Chamber �T1 (tYPical) C�J INSTALL PER TRENCH: (mfd by InfiltratorSystems,���.) O InstaN pursuant to manufacturer's instructions. �=_ Quick4 Std-W @ 20 ft� EISA/chamber= 220 ft2 �1 U'1 + �_ Pairs of end caps @ 6 ftZ EISA/pair= 6 ftZ = Proposed EISA per trench= 226 ft2 Required Infiltration Area= 429 ft2 Distribution Method: x 452 trenches = Proposed Total EISA = 452 ftz branched manifold � PAGE 4 OF 5 GRAVITY-DOSED SEPTIC / PUMP TANK SPECIFICATIONS (No Scale) 4"0 Vent Pipe >10 ft from Building Electrical must comply with 12"Min.or 2.0 ft above SPS 316 and NEC 300 Established Flood Elevation Extend manhole riser as necessary. �ry���� Weatherproof Approved Junction Box Vent Cap Approved Locking Manhole IMPORTANT: with Waming Label Attached (�YP���) Anchor tank(s)as necessary �--Conduit pursuant to SPS 383.43(8)(g) a°Min,or 2.0 ft above �Established Fiood Elevation (�YPical) �Airtight Seal ' Finished Grade � ' Quick Disconnect � 18"Min. CAPACITIES @ 1�•$2 gal�n %: . , .... . ° ttiP'�i> a. � . � Depth{in) Volume (gal) A 24.� 283.68 *� �/yy�p �qpprovedJointswith � Hole Approved Pipe 3 ft onto B 2.� 23.64 q Solid Ground (ryPi�q [C] 5.0 53.10 � _Alarm D 12.0 141.84 �B —o� ► ��J PUMP-OFF y Pump ELEVATION = 91.00 ft *Pump Tank Liquid Level = 43 in —� —°ff ' I ° INSIDE BOTTOM Force Main Diameter = 2 i� Concrete B1� ELEVATION = 90.00 ft . . . . : .. Force Main Length = �� ft 3"Approved Bedding Material Benealh Tank Force Main Void Volume = �•79 gal [CJ Total Dose Volume (TDV) = 59.10 gal/dose �(<0.2X design flow+force main void volume) Vertical Lift = $'� ft PUMP TANK: SEPTIC TANK(S): Volume = 508.26 gal Total Volume = 84� gal Manufacturer: Wleser Concrete Inc Manufacturer(s): Wieser Concrete Pump Manufacturer: Zoeller Install approved effluent filter at the septic tank outlet Pump Model: BN53 immediatel u stream of the um tank inlet. (See attached pump curve.) � � p P Controls/Alarm Manufacturer: SJE Rhombus Filter Manufacturer: Llfetime Filter LLC Controls/A�arm Model: Tank Alert AB Filter Model: LT-1/8 Float switches containinq mercu�r r are prohibited. PAGE40F � � In-ground Gravity Management Plan s � IMPORTANT: The owner of this in-ground 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 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 Dispersal Area Operatinq Limits: Design Flow= 300 gpd; BODS S 220 mgL''; TSS <_ 150 mgL''; FOG _< 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 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., 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, controls, 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 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 according to manufacturer's specifications. 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: R8y VISOCKy Phone: 715-634-1679 Local government unit: SaWy@I' COUtI�/ ZOflltlg & COC1S2t�/at1011 Phone: 715-634-8288 �ocal government unit address: 1061 O Maltl St, Suite 49 ; Hayward, V1ll ZiP: 54843 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 Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33,Wisc. Admin. Code. � TOTAL DYNAMIC HEAD/FLOW ' w W PER MINUTE � � PUMP PERFORMANCE CURVE MODELS 53/55/57/59 EFFLUENTAND DEWATERING 0 6 2o MODEL 53/55/57/59 � Feet Meters Gal. Liters U � 15 5 �.5 43 163 � 4 10 3.0 34 129 � 15 4.6 19 72 J 10 a _. 0 8u 009897 Shut-off Head: 19.25 ft.(5.9m) 2 5 37I8 � 83l16 4 5/8 1 1Y1-11 1/2 NPT � ,0 2 a� o ao 50 � 37/8 GALLONS � LITERS 0 80 160 � � FLOW PER MINUTE �� a � � CONSULT FACTORY i � FOR SPECIAL APPLICATIONS i � • Variable level float switches available. — i i • Variable level long cycle systems availabie. • Available with special cord lengths of 15', 25', 35' and 50'. i • Alarm systems available. i ,o v,s � • Duplex systems available. ! i ! } i - 3 3l32 � _�_ SK858 Sin IeSeal Convol Selection ustin s iELECTION GUIDE Model Vons Phase Mode am Sim a Du �ex CSA UL 1. Integral float operated mechanical switch,no extemal control required. M53155&M57/59 ��5 � auto 9.� 1 -- Y v 2. Single piggyback variable level float switch or double piggyback variable level N53155&N57/59 115 1 Non 9.7 2 3 or 4&5 Y Y float switch.Refer to FM0477. •BN53 t15 1 Auto 97 ` — Y Y 3. Mechanical altemator°M-P�ak"10-0072 or 10-0075. 'BN57 115 1 Auto 9.7 ' — N Y 4.See FM0712 for correct model of Eledrical Altemator. 'BE53157 230 1 Auto 4.8 ' Y Y D53/55&D57/59 230 1 Auto 4.8 1 Y Y 5.Variable level control switch 10-0225 used as a conVol activator,Wlth EI2CtfIC21 E53/55 R E57159 230 1 Non 4.8 2 3 or 4�5 Y Y Altemator(3)or(4)float system. 'Single piggyback switch included. 4 CAU710N Forinfortna6ononadditionalZcellerproductsrefertocatalogonPiggybackVariableLevelFloatSwitches,FM0477; All installation of controls,protrction devices and wiring should be done by a pualified ElectricalAltemator,FM0486;MechanicalAltemator,FM0495;Sump/Sewage Basins,FM0487;and Single Phase licensed electrician. All electrical and safety codes should be followed including the Simplex Pump Control/Alarm Systems,fM0732. most recent National Electric Code(NEC)and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. ----------_ ___— ------ MAIL 7t7:P.O.BOX 16347 ZLouisville,KY 40256-0347 Manufacturers of.. 0 SHIP iD: 3649 Cane Run Road Louisville,KY 40211-1961 �[�q[/TYPUMP9 SNCE ����7 " www.zoeller.com PVMP !O. (l (�2)778-2731•1(800)928-PUMP FAX(502)774-3624 —_ ----------------------- ---- O Copyright 2006 Zoeller Co.All rights reserved. W840/500-MR 13�„ TANK SPECIFICATIONS � � DIMENSIONS: a a WALL: 2 1/2" w n BOTTOM: 3" a a COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER � i ' � � HEIGHT: 59 1/2" O.D. � ���� \ LENGTH: 113 3/48" O.D. �� / IIII \ WIDTH: 93" 0.0. .- 4" CAST-A-SEAL � 4" CAST-A-SEAL BELOW INLET: 48° O.D. w �- � � ����� �-t LIQUID LEVEL: 43" a > k-`' � �24" / � I Ol WEIGHT: 11,150 LBS. � � o °' TYP � l � � INLET AND OUTLET: \ J \ II II \� 4" CAST-A-SEAL BOOT OR EQUAL a o �� FILTER OR �III /� GASKET, CAST-A-SEAL BOOT OR EQUAL 3 0 �, � BAFFLE IIII / INLET ANO OUTLET BAFFLE AND FILTER: o WISCONSIN, SEE DETAIL #10 � � � � � — — � � ' (OTHER STATES SEE CHART) Q � w � a � LIQUID CAPACITY: 19.61 GAL/IN (SEPTIC) � � '` 11.82 GAL/IN (PUMP) y,� � a LOAOING DESIGN: 8' 0" UNSATURATED SOIL ~ � W � � C� � cfl C � �� � Zoo W TANK CAN BE USED AS: Q � N � 4" VENT SEPTIC/SEPTIC, SEPTIC/PUMP � � N Q � r� OR SEPTIC/SIPHON W � � � COVER: MIX DESIGN #8 (NO FIBER) � _ � TANK: MIX DESIGN �10 (STRUCTURAL FIBER) � �� — — — � � !NLET — — — �� «, - — _ —_ _ OUTLET CUSTOMIZED TANKS: � � ' - I - - FOR CUSTOM TANKS CONTACT WIESER CONCRETE rn '"`'' �� � �n ' � 2�" `n � � � �' � � Q I.f 1.1 I � z � - - � � s —�� o a � � � U � PUMP PAD o�p ~ M DRAWINGS SUBMITTED 3 N SIDE VIEW FOR APPROVAL APPROVED BY: SHEET N0. APPROVAL DATE: 1 � OF . TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS PRODUCTS NEEDED BY: / ,� '"'�=�'"—'�"�r-� PRIVATE ONSITE WASTE TREATMENT county ��. ,, „' i>t"; o��p ��;, SYSTEMS SaWyer ;;��l s ,_� ( POWTS) �o� � ,;;' ��`°` --"�s`� INSPECTION REPORT Sanitary Permit No: �>,_,�,�r�, Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION ��,,, ��c.� Personal infonnation you provide may bc used for secondary purposes[Privacy Law,s. 15.04(1)(m)) � Permit Holder's Name: ❑City ❑ Village I�,Town of: State Plan Transaction ID#: �al�v`�S�--Qacl� Wl�,1 �Z✓1 I�au�n� (-a� — Insp BM Elev: BM Description: Parcei Tax No: lvo,o' 9�fi`ayrz=ca� o-��,�.�. N,., S�co�- o�Y —�Y( —30 -5�7� TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic r,,,t,�..�-_ c�p Benchmark �oo,o' Dosing _ �\pb b Aeration Bldg. Sewer g'�b� Holding St/Ht Inlet `jb•$� TANK SETBACK INFORMATION St/Ht Outlet `1,6,6� TANK TO P/L WELL BLDG vENrTo ROAD Dt Inlet AIRINTAKE Septic �S� .��5-� +}o� �,b� NA Dt Bottom 13.o� Dosing � •� NA Installation " " Contour Aeration NA Header/Man. 4$.c' Holding Dist. Pipe PUMP 1 SIPHON INFORMATION infiltrative �7.a� Surface Manufacturer �,,.e��.c- Demand Final Grade Model Number 'dN�� GPM H� �• q g'S t TDH S Lift Friction Loss Sys Head TDH Ft Forcemain L .�Z � Dia " Dist. To Well DISPERSAL CELL INFOR ATION DIMENSIONS W ' � � #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav �C Conv ❑ Aggregate ����, INFORMATION P I L Bldg Well Waters °� GP � Chamber Model Number: ❑ EZFIow CELL TO �-S' h�' �!-S D' �o�� ❑ Mound o Other �y fi - - _—_----- --- --- ------_ DISTRIBUTION SYSTEM X Pressure Systems Only Header I Manifold Distribution Pipe(s) �X Hole Size X Hole Observation Pipes—�1 Length Dia Length Dia Spac I __ Spacing ❑Yes ❑ No � ----.—_-- SOIL COVER -- _ -- - - - Depth Over Depth Over Depth of Seeded/Sodded Mulched Cell Center �ell Edges Topsoil _ [ ❑Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.) ��„S�ll�( � (�6�a� —_� _ ; — � Plan revision required?❑Yes❑ No � �' �5 J L�2�"3�3 I �— - - -� �� � Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AOOITIONAL C�MMENTS ANO SKETCH SANITARY PEFMIT Nt1M8EA�._ a'��Q(`'1_ __ . ��� �°.�. �� �D g�ray� � U �, �� ��) �) �' ay� � � \�� � �H� IA� �� xa � "� / ' w�'S� ; }d� �4oIS�O ,�1��' 1 � � � � i s�°�I ��� 0 �-- ���,� ���� �� �