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�
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SN�oo' sE corv�e�c—
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d�sa��
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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�'
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��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_ __
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