HomeMy WebLinkAbout024-741-09-5318-SAN-2022-111 ��'` "' Industry Services Division County r (�
4822 Madison Yards Way y �'^vy�� �
,�_ - Madison,WI 53705 Sanitary PermitNumber(to be filled in by C �
' �= P.O.Box 7302 +
Madison,WI 53707 �\ � �?j � � � 1 �
Sanitary Permit Application ➢���pY� State Transaction Number �
[n accordance with SPS 383.21(2),Wis.Adm.Code,submission ofthis form to the appropriate govemmental unit _
is required prior to obtaining a sanitery permit.Note:Application fortns for state-owned POWTS are submitted to Project Address(if different then mailing adc �
the Department of Safety and Professional Services.Personal information you provide may be used for secondary �.
purposes in accordance with the Privaey Law,s. 15.04(1)(m),Stats. /)//�
I.Application Information—Please Print All Information ��� ��
Property Owners Name Parcel#
��h 3�►,M�,nn oZy-7 y/p9 53�8
Property Owner's Mailing Address Property Location
�0 612 N o g r<<n H;�( �� co�c.Lot 3
City,State Zip Code Phone Number
����� � V' � SYB Y 3 '/,, '/., Section � y
II.Type of Building(check all that apply) 1.ot# � T y� N R �7 E or�
�l or 2 Family Dwelling—Number ofBedrooms Subdivision Name
1�-'�
Block# �—
�ublic/Commercial—Describe Use �
❑City of
❑State Owned—Describe Use CSM Number illage of
.3� �i2 �7�7� �ownot' R�..n� /wk,e.
III.Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C if
a licable.
`�' ew S stem e lacement S stem her Modification to Existin S stem ex lain) Additional Pretreatment Unit ex lain
Y �t p Y g�Y � p ❑ � P )
IJ
B' ❑Flolding Tank -Ground QAt-Grade �Mound Individual Site Design Other Type(explain)
onventional)
C• ❑Renewal Before �Revision hange of Plumber �I'ransfer to New Owner '�st Previous Permit Number and Date Issued
Expiration
IV.Dis ersaUTreatment Area and Tank Information:
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(sfl System Elevation
yso , -t cY3 � Z q s', q� _ q 3, �.�
Capacity in Total #of Manufacturer
�
Tank Information Gallons Gallons Units � U v $ y
New Tanks Existing Tanks ` eo y a � � � `�
w U =n �ti v� w C7 0.�
Septic or Holding Tank 1 pVa `OQ ! V��t,r�
1
Dosing Chamber 6 O v � �
V.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name(Print) Plumber's Signature MP/MPRS Number Business Phone Number
Dylan Schultz 1516129 715-558-5904
Plumber's Address(Street,City,State,Zip Code)
7076N Stone Lake RD, Stone Lake, WI, 54876
VI.C u ty/Department Use Only
�.Ap ❑Disapproved Fermit Fee Date Issued Issuing Agent Signature
�W ❑Owner Given Reason for Denial $ `��'� � l+� I"�`� �1��`��"`l TG�/��
Conditions of Approval/Reasons for Disapproval D �- '
� -;__ �
CST �a-- � �� �UN _ __ _ �- ; �
C
I 1 5 2�22
�I INQ . .---_�
Sa1��VYE� �•.��.4�.�I r
ZOt�fdG ADMINISTr"�AT10t�
Attach to complete plans for the system and submit to the County only on paper not Iess than 8 tn x 11 inches in size
SBD-6398(R.02/22) NO REFUNDS AFTER
ISSUE OF PERM�T
PAGE 1 OF 5
In-Ground Dosed-Gravity Plan
Index & Cover Sheet
Component Manual Design References:
Version�8, SBD-10705-P (N.01/01, R. 10/12),, ,
Pg 1 of 5 a' � 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
Owner Name(s): �0�� 30�`Mw�r� Phone: - -
Owner Address: l06 i1N o3�;� N�II �� Zip; S`ffly 3
Project Address: /��("
Govt. Lot: 3 1/4 of 1/4, Section a 1 , T y� N-R �� E ❑or W�
Township: 1��n� �•,k� County: S�W{�
Project Parcel ID #: 02 �i 7`��095 31S
Designer Information
Designer Name: Dylan Schultz Phone: 715 _ 558 _ 5904
Designer Address: �6880W Metcalf Rd Stone Lake WI 54876 Zip: 54876
E-fl181�: C�yIdflSChUI�Z18@g(1'1c111.00111 ILissuaeersen���ctib,a��proral .t�antu.
License Number: 1516129
Remarks:
Signature: Date: b - s�z Z
Or n I signa required on each submitted copy.
CHECK BO%AS APPLICABLE. CHECK 80X AS APPLICABLE.
� SOIL EVALUATION o s�a�e: ��40' so 80 �SYSTEM PAGE 2 OF
SITE MAP PLOT PLAN
PROJECT NAME: oEsicN F�ow� y�v cco
�o'
Attach design flow calculations for commercial plans.
Pao�Ecr nDDREss: � Pipe Material/ASTM Standard(Tables 384.30-3&384.30-5)
'Ov N SanilarySewer'. �4�� /
BM SYmbd: � BM Eleva[ion: FT
� ^ � �� � � � Force Main'. Cc�. �fd l
BM Descnption' a�� VS�^'Do
ind�wta�onn by I MPORTANT:
Slope Gratlient(%) Wetl Symbd(if applicable): � tlraw�ng an er`w. Show gmund elevation contou�s at suitable intervals.
of Tes�ed Ne3: on the appmprke lire.
N� �e(I
�M _ �a�- �-o S��IGf
� (oo ���
�1 -
a�.�.� On
�Z_ 9�t, �Z
Dylan Schultz
a � �Q " g� �� 7076N Stone Lake Rd
V� q c� , g 6 � Stone Lake, WI 54g7g
�C�� �\ MPRS 1516129
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IN-GROUND DOSED-GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down-sizing credit)
�
`"'" ,r TYPICAL TRENCH
SOIL COVER (rypi�l'
CROSS SECTION VIEW
12�� (No Scale)
min.Uench
tlepth
(HPicaq •
a'.
. d '�,
� �� ''� .� . .
�ryP���� ,' 9 f.f � Provide minimum 3 ft
� ' q 5���" separationbelweenirenches.
System Elevation = ft
(rypical)
Quick4 Standarcl-W
w/ End Cap Ohservation Plpe
t ical (Show location of inlet I outlet pipe connection on plan view.) �hP���> TYpICAL TRENCH
� YP ) Install per manufacturefs
��c��uo�s. PLAN VIEW
(No Scale)
� t1Blkallt�t�AClw . . .:_— _ - - JL — _ - - _ _ — J� _ _ _ , �
// �
I �'4 . . .� ; . , , .. � A = 3.Oft
Lvt�;���yrr�a,�r - - - - - - -��- - - - - - - - �� - - - - (ryv���)
— — — — — J
t �
B = �G ft =; �
«'P���� Quick4 Standard-W Chamber �TI
(rypical) W
INSTALL PER TRENCH: �mm ey i�ei«aco.s��a�, i�o.�
/ 32� Instell pursuant to menufacturers instruc�bns 0
` � Quick4 Std-W @ 20 ft� EISAlchamber= ft' �
+ � Pairs of end caps @ 6 ft'EISAlpair = � ft' �
= Proposed EISA per trench = 2 ft' Required Infiltration Area = �'Y� ft' Distribution Method:
x 2 trenches = Proposed Total EISA = ��Z ft� ti� ' ln"M� -�o
� 'N"�Y
�
PAGE40F5
GRAVITY-DOSED
SEPTIC / PUMP TANK SPECIFICATIONS
(No Scale)
4"9 Vent Pipe
>70 fl fmm
Building Eleclnnl must comply wilh
72"Min.or2.ORabove SPS316andNEC300
Eslablished Flood Eleva�ion Weatherproof EMend manhole nser as necessary.
(typinl) Junction Box
Approvetl qpproved Locking Manhole
IMPORTANT: Vent Cav with Waming Label Attached
(rypical)
Mchor tank(s)as necessary �cor,d��i
pursuant to SPS 383.43(8)(g) a�•M��.o�z.o a abo�a
Eslablishad Flood Elevation
(ypiCdl)
�Aidight Seal
Finished Grade
Ouick Disconnect
'� 18'Min.
CAPACITIES @ gaUn y . . �ryP���>
:. q i
Depth(in) Volume(gal)
A � � 2 �,6� — *—i—
Weep ApprovedJointsvnth
` Hole ppprpyed Pipe 3 ft onto
B 2.0 3 �. J Z q Solid Ground
[C] �3u�og � �ha��o
_Alartn •
� (Z �0�. �Z TB� �—On
* 3� � �c� PUMP-OFF C'�
Pump Tank Liquid Level = in
� P"`"P _orr ELEVATION = �� � ft
° INSIDE BOTTOM �5
Force Main Diameter =��in c°""�'a O 7
e'°°k ELEVATION = ft
Foroe Main Length = �ft 3��"PP'°"a°�°a��9 Meia�ei ee��m ra�k
Force Main Void Volume = �3 ' � gal
[C] Total Dose Volume TDV = /� 3 • ` gaUdose
(<02X tlesign flow+force main void volume)
Vertical Lift = � � � ft
PUMP TANK: SEPTIC TANK(S):
Volume = �4o gal Totai Volume = /O�o gal
Manufacture �t S'� Manufacturer(s): w es'�
Pump Manufacturer: Zoc����
Install approved effluent filter at the septic tank outlet
Pump Model: a � ��a��n�P�mP�,rve> immediately u�stream of the pump tank inlet.
Controls/Alarm Manufacturer: �� Filter Manufacturer: �°� �o��
Controls/Alarm Model: Z
Filter Modei:
Float switches containing mercury are orohibited.
WLP1000/600-MR
TANK SPECIFICATIONS � �
a i
12'-6" DfMENS10NS: � o
WALL: 3• a a
4" CAST-A-SEAL 4" CAST-A-SEAL BOTTOM: 3�
CAVER: 5'
--�-------__-_._ MANNOLE: 24" I.D. PRECAST CONCREiE RISER o
�4=----------------��r-------� HEIGHT: 58'
� i i�h � i � LENGiN: 12'-B'
i � „ �li� � i r WIDTH: 7'-0" �
i i �-� m'L�. -� ijji a _ j, BELOW INLET: 42'
� � i� � �j� � �� UWID L£VEL: 38' � a
� �I � � i � p� WFJGHT: 14,9701BS. � �
: `, , ��T J' " � gd
I � `--' ` -' �II� • • � INLET AND WTLET: a o 0
1 i �III I � 4' CAST-A-SEAL B00T OR EWAL GASKET � m o a
! � FILTER OR �F�� � �, o �
� � BAFFLE IF�I I �' `9 � �•
� i ���� � � INLET AND OUTLET BAFFLE AND FlIiER: � � a �
'r-- --�---;-----�i�----•-----�� WISCONSIN. SEE DETAIL /10 u> o o �
-- - (OTHER STAiES SEE CHAR� W u�i
UWID CAPAqTY: 27.88 GAL/IN (SEP11C) ~ �
TOP HEW 16.78 GAL/IN (PUMP) � �
�
LOADING DESIGN: 8'-0' UNSAiURATED SOIL CO � �
TANK CAN BE USED AS: C9 �' �
SEPTIC/SEPTIC, SEP11C/PUMP, � �
N� OR SEP11C/SIPHON � o �
a v 4� vENT COVER: MIX DESIGN /8 (NO FlBER) � 3 0
� TANK: MIX DESIGN /10 (STRUCiURAL FlBER) � CO
W �
� CUSTOMIZED TANKS: � �
____ ___- ____ �_ FOR WSTOM TANKS CONTACT WIESER CONCRETE � 3
INL T - OUTLET
� � - - � ii � i . �n
�
� ^ U I � II t0 -� I � a �
v� N a e � � �.� „� � � � � � Q
d � a 1 n I-I d I �,µ r7 O �
�I I 1 �a �' 0 Z
3„ ` --`--- I I 1 � � Q
i_...__-__ _ _�-1 '��__r—�7 � �
REVIEWED BY g U
� PUMP PAD REVIEW DATE � W
DRAWINGS SUBMITTED y
SIDE VIEW FOR APPROVAL
APPROVED BV: SFiEET NO.
APPROVAL DATE: � �
�
PRODUCTS NEEDED BY: / �
TANKS ARE MANUFAC'NRED TO MEET OR EXCEm ASTM C-1227 REWIREMENTS
TOTAL DYNAM/C HEAD �
FLOW PER M/NUTE � w PUMP PERFORMANCE CURVE
MODEL 98
MODEL 98 z5
Feet Meters Gal. Liters �6 zo
5 1.5 72 273 �
10 3.0 61 231 � 15
0 4
15 4.6 45 170 � ,o
20 7.1 25 95 �z -
Shut-off Head: 23 ft.7.Om 5
0
70 20 30 40 50 60 70 80
GAlLONS
LITERS 0 60 160 240
FLOW PER MINUTE
MODEL COMPARISON
Model
Seal Mode Volts Ph Amps HP Hz Lbs Kg Simplex Duptex
M98 Single Auto 115 1 9.4 1/2 60 36 16 1 4
N98 Single Non 115 7 9.4 1/2 60 36 i6 2or3 4
D98 Single Auto 230 1 4.7 1/2 60 36 16 1 6
E98 Single Non 230 1 4.7 1/2 60 35 16 2or3 4
BN98 Single Auto 715 1 9.4 1/2 60 37 17 * --
BE98 Single Auto 230 1 9.4 1/2 60 40 18 ' --
'BN and BE models indude a 20'(6 m)piggybadc variable level pump switM.Additional cord lengths are available in 25'(8 m)antl 35'(11 m).50'(15 m)cords are
available for 230 V units only.
SELELTION GU/DE
1. Integral float-operated mechanical switch,no e�cternal control required.
2. For automatic,use single piggyback variable level float switch ordouble piggyback variable level float switch.Referto FM0477.
3. See FM1228 for correa model of simplex control panel.
4. See FM0712 for correct model of duplex control pane�or FM1663 for a residential alternator system.
OPTIONAL PUMP STAND P/N 10-2421 pr,.
•Reduces potential clogging by debris F� "Easy assembly'
•Repiaces rocks or bricks under the pump �p„mpaa'ocnaryep�pe
•Made of durable,noncorrosive ABS nm�inawea.�
•Raises pump 2"(5 cm)off bottom af basin
•Provides the abiliry to raise intake by adding sections of tYx"or 2"
(ON40 or ON50)PVC piping
•Anaches securely to pump
•Accommodates sump,dewatering and effluent applications
NOTE:Make sure float is free from obstruction.
ACAUTION All ins[allation of con[rols,protection tlevices and wiring sho�ld be done by a qualitietl IicenseA elecnician. All elactricel antl satery codes should be
toi�owee including the mos[recan[Netional Elechical Code INECI entl the Occupational Satety and Heelth Act IOSHA�.
OO Copyright 2016 Zoel�er�Co.All rights reserved.
502-778-2731 �800-928-7867 �3649 Cane Run Road � Louisville,KY 40211-1961 �www.zoeller.com
PAGE40F4
In-ground Dosed-Gravity Management Plan
IMPORTANT:
The owner of this in-ground dosed-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 shali be considered a human health hazard if not maintained in accordance with this approved management
plan. Furthermore, ail inspection and maintenance activities shail be pertormed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3), Wisc. Admin. Code.
Maximum Dispersal Area Oaeratins� Limits:
Design Flow= ��U gpd; BODs 5 220 mgL''; TSS 5150 mgL''; FOG <_30 mgL''
Insoectlon 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, eta)
o material fatigue (i.e., leaks, breaks, corrosion, etc.j
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-cyciing, float switch settings, etc.)
o electrical components- if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.)
o disiribution lateral or lateral orifice piugging (measure lateral distal pressure-compare to design specification)
o surface discharge of effluent or sewage back-up into struciure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Seotic and dose tank(s1 shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
Stats.when the volume of aolids in the ta�k(s)exceeds one-third (1/3)the Iiquid volume of the tank(s) or
as required by local ordinance. Disposal of contents shail be pursuant to NR 113,Wisc. Admin. Code.
o Effluent fflteKs)shall be inspected every 3 years and shali 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 Wlsc. Admin. Code. Report any component failure or malfunction to:
Name of individual or company: p��"'� S�l`"'1�Z Phone: 7�S- SS$`-S pu y
Local government unit: Shw�,ei c an��i C JhiA.) Phone:
Local govemment unit address: �����✓-�� J w' Z�p� s�� �
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1),Wisc. Admin.
Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code.
No product for chemical or physical restoration of the PONffS may be used unless approved by the department in
accordance with SPS 384, Wisc.Admin. Code.
Contlnaencv Plan
In the event that any failed treaVnent component of this POWTS cannot be repaired, it shall be replaced pursuant to
a pian submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be
abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soiis.
Svstem Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
/:,."``'"T"""' PRIVATE ONSITE WASTE TREATMENT county
-- �.�;,.
,,;�� ..r�.
�'�j> °s 1�} SYSTEMS SaW er
���� P$�%� ( POW'TS) Y
UfFS.ti/o.uA�`'%
INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �� " ( I (
Personal infonnation you provide may be used for secondary purposes[Privacy Iaw,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑' Village Town of: State Plan Transaction ID#:
��,h ���,�,a�� ,�o�,� �,� �-
Insp BM Elev: BM Description: Parcel Tax No:
�oo.a� �a;< <t- n�o�,.► `r. ��ss.�oo� fjo2� --7Y�-c�q� S31`�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �,,��,e�— _ (cAp Benchmark (op,o�
Dosing — ��...,�p (,67r
Aeration Bldg. Sewer �p,c�c��
Holding St/Ht Inlet �70.$ '
TANK SETBACK INFORMATION St/Ht Outlet �tb,o g r
TANK TO P/L WELL BLDG vENTro ROAD Dt Inlet
AIR INTAKE
Septic N '�'l 9 NA Dt Bottom 8�3 t
Dosing �� �� �� �� NA Installation
Contour
Aeration NA Header/Man. f(�,'�
Holding Dist. Pipe
Infiltrative �
PUMP 1 SIPHON INFORMATION Surface `��'�
Manufacturer ;� Demar�d Final Grade
Model Number �� GPM
TDH� Lift Friction Loss Sys Head TDH Ft
Forcemain L � b Dia �� Dist.To Well
DISPERSAL CELL INFOR ATI N
DIMENSIONS W � L (o}� ( #of Cells Type of System Distribution Media Manufacturer:
SETBACK � Conv ❑ Aggregate �t—
P/L Bldg Well OHWM of Nav � IGP Chamber �` I '
INFORMATION Waters � AG � EZFIow Motlel Number:
CELL TO y2 �/ � ❑ Mound o Other �
—__— _ _ 1'�..
_-- --- -- --- -- —--
DISTRIBUTION SYSTEM X Pressure Systems Only
— -— —_ -
Header/Manifold Distnbution Pipe(s) I X Hole Size X Hole Observation Pipes
--—
Length Dia Length Dia _ Spac i Spacing ❑Yes ❑ No �
SOIL COVER -- —
— - ---- -- -- ----- — - --
Depth Over Depth Over Depth uf Seeded/Sodded Mulched
Cell Center 1 Cell Edges � Topsoil____ _ � ❑Yes ❑ No � ❑Yes ❑ N�
COMMENTS: (Include code discrepancies, persons present, etc.)
���i� �lY ���
� __ �_ ____
Plan revision required?�Yes ❑ No oz �� 2 (� �c� � '/
._ fo �
--1-� - �-- _—--
Use other sitle for additional information Date POUJTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A��ITIONAL COMMENTS ANO SKETCH
SANITAAY PERMIT NUMBEA: oz�-L�___
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