HomeMy WebLinkAbout018-837-21-1203-SAN-2022-171 Department of Safety c°°°ty �
����� & Professional Services, �
a : Sanitary ermit Num (to be filled in by( �
�: , Industry Services Division
(�"3 �l � ��� g.�
Sanita� Peri,l,llt AppllCatl�n State Transaction Number �
�- �
In accordance with SPS 383.21(2),Wis.Adm.Code,submission ofthis form to the appropriate governmcntal unit .—
is required prior to obtaining a sanitary perntit.Note:Application forms for state�wned POWTS are submiited to Project Address(if different than mailing ai J
the Department of Safety and Profcssional Services.Personal information you provide may be used for secondary ,r
purposes in accordance with the Privacy Law,s. 15.041 I)(m),Stats.
l.Application Information-Ptease Print All Information 50.��
Property Owner s Name Parcel# ������_��_���
\l� ° �. A.V�-V �
Property Owner's M`ailing Address Property Loe�t�on
� . ' 1/� �O�C 1
�� �
Ci ,State "Lip Code Phone Number , ,r-
�,�.`^ 'tTC �� , � � � �� �� y,, �'G '!�, Sec4on_�22j_
II.Type of Building(check all that apply) Lot# 7 N x d E or
�I or 2 Family Dwelling-Number of Bedrooms �__ � Subdivision Name
Block#
❑PubliclCommercial-Describe Use .—
❑City of
❑State Owned-Describe Use CSM Number ❑Village of
�Town of rnSP���
iII.Type of POWTS Permit:(Check either"New"or"ReplacemenN'and other applicable on line A. Check one box on line B.Complete line C if
a licable.)
A.
❑ New System � Replacement System ❑ Other Modification to E:xisting System(explain) ❑ Additional Pretreatment Unit(explain)
B.
❑ Hoiding Tank �In-Ground ❑ At-Grade ❑ Mound ❑ Individual Site Design ❑ Other Type(explain)
(conventional)
_ist Pre�ious Permit Number and Date Issued
C• ❑ Renewa]Before ❑ Revision ❑ Change of Plumber ❑ l�ransfer to New Owncr �
Expiration �.QO� ,
IV.Dispersal/'I'reatment Area and Tank Information:
Design Flow(b�d) Design Soil Application Rate(gpd/sf� Dispersal Area Required(st� Dispersal Area Proposed(s� Systcm Ele�'atioi .
, ; , � 7�� �`r.c��
Capacity in Total #of Manufacturer
�
Tank Information Gallons Gallons Units � y v � Y N �
New Tanks Existing Tanks y G � ` � p _ �
a U v� �, v� i.�. C7 w
SeQ[ic or Hoiding Tank � O � I ,
Dosing Chamber �?/'l ,r�0 ' �� �
w �
V.Responsibility Statement- 1,the undersigned,assume responsibility for installaHon of the POWTS shown on the attached plans.
Plumber's Nume(Print) PIuL�s Signature MP/MPRS Number Business Phone Number
� � - C ls ss�
Pl mber' Address(Street,City,State,"Lip Code)
057 � `T` � � �- f�. l � I.t�
VI.Coun /Department Use On►y
� B� Pennit Fec llate Issued Issuing Agent Signaturc
Appro d ❑Disapproccd ,
❑Owner Given Reason for Denial � [�/va� � I��� ��� �'�2/��""t �"-�'`��
Conditions of Approval easons for Disapproval
� � �ate �� ����� ._ I`"�����!����--n �
0� �� �
�'
��
� ��
�hk# �� __._..._..._..__ `-= �UL � 4 2022 i'
�CS� �� - (D� �cpt#.L�.� Wor�a �'�.�1 S , , -----_
sA�vY�� ca.;,:,; ;:
�_ Attach to mplete plans ibr the s}slem and subroit to the County only on paper not less than 8 U2 x ll mc es m e �
GS� b� �-�
-6398(R.03/22) NO REFJNDS AFTER
ISSUE OF PE"ftMIT
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PAGE 1 OF 5
In-Ground Dosed -Gravity Plan
Index & Cover Sheet
Component Manua/ Design References:
Version';�'Q, SBD-10705-P (N.01/01 , R. 10/12) ,
. ,
Pg 1 of 5 �� � Index & Cover Sheet
Pg 2 of 5 Plot Pian
Pg 3 of 5 Dispersa! 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
Soii Evaluation Report & Site Map
Project Name / Description
,
Owner Name(s): i �, , ,�'�� �,� (',�L� Phone: - -
Owner Address: l ` l� (j-i�p�(.C��f(1;��- LF'�, �GSC�?QCCI�'t�, Zip; -,rj �, ,�
Project Address: ��
Govt. Lot: . � u7 �1i4 of IIL� 1 /4, Section��, T��N-R�E ❑or W,�
Township: � r County: �Q�
Project Parcel ID #: 0 ��' — �'�y�7 —��, — �a�
Designer Information
Designer Name: ��(;�.Q1. �j-��� Phone: ��S ��- � (G�7�
DesignerAddress: D� / �, �y� (',(,(f�, Z�P. ����_
E-mail: :�;�, . j
«:_� � �'.,!. , �' �1��;�, g1 t,j::.
,. �t;�t.
License Number: �R�,��
Remarks:
Signature: - - �- Date: �D �� —�-�
Originalsignature required on each submitted copy.
Ow�et- = L,P�-•
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�IV-�I��JIJNC7 C�E�AVlTY DIS�'ERSAL /�RE� :�<:ptic Iani;(s)Manufac;turer:
��t!`�y���
Uniform �{ev�tian Trenches with �Z12U3HP Bundl�� s�n�;,;,.,,nk�5>��,,,,n�,csj:
3-ffi Trench (down-sizing crPdit) ,,d,,,.
' 1 `g,rl ,...,qal r��l 4��d
[((lucrri Fiiler M7nufacturer.
_.�_��---_�_� ...S�G----�•--•_�_..___�__._..1�_�._. � _�__._.�__�_ - ; .
� ' • r^ ��. .
1
. ..._ . :_ /
._. .__ , ���hi.7Z° E:fflu�anl f fltfn Mnd��l!/' .
� ���.��- - '
(';n,ntr�xtlle I _.:j� _ ---� (�Y{�fc;il? ��
: _ Cavi!r __ _.._ ______._._----,---._..____...._..---,..__.--- ---------___._._
f sc�a_c;ovr_�: � = .�.��_ . TYPICl�I� TRENCM
:fI _�� ' t�� - _ �
,,,�,, ,,,,,,�:,,� ° � . Ct�OSS SFGTION VIFVV
a��i,u� �
(�vt���:;,q -�— ___ _.._ __� ��.�1`, • :.L " (�IO �aC���} Ol3Sr(2VATlON F'fP(:DET/111.
/ , � : Pdo>r.;,�.�)
�i,..
�� 6 P �it:ft?W-�IYllll(II '-
:iySlC't11 f=�i:v;ilion -,��,.(I. Shp<,`,qi(fcnr.aq _ y W,m•�, Fxuslwd Gridu
�lyr)ICiI��
I��COVICIE I111�1ItT1U1T1� (� , i (irudr.hndEruwdud)
SeE-»ratior� brtWn(:Il �I'Cf1C�1(?:i. A"ViI�V(;Pipn.._.__._.±.�_ ._ IopnudC:nvcr
lop c�l pipu In i��nnin;du (min.1 f�o{)
;d ra�d�nw!Gniahnd i��;id�� . '
(4)V4"-I117"Xli";ilvl-� -_... �.__.
TY�'IGf�� Z�����C�-� (Show luc�tiori o�irilc;�/ouuc�l pi�x:�:oru�ec�ion rm r�l:m vicw.) c,,sm ;�r:���
I'"�/il V V��V Y nnr.l,onnc�llcvir.r, .___'., -" Inftlu;i6un
�n� pD�;erv;ihun pipu�,h;dl hu ins4dlwl Y��\`��_ :/�;/�/ SuAor.i!
�nIQ S'�f�lE ;d�uncUun bulwuun twu unll:�. `.:�"'.�'." --�
� F�C'flUfc]I6?d Laler�l Ob;eivntiont'ipc .- '�
-- �typic�al) (ivnt�:�,�� (�vPicai)�
_ � . __ .__. .,.�_ _r�... ___ _.. .._. ._._ _._ .._ _... �-. i, .�
I-° °-1
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, .� � .. ,ti
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_ _` :_=. :,. __._-____... -= -- - 30 k
I-.:-_ _ .. _ ._ •
-- - ________.-.-----
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: ....�
�: _ _ . _. _ _ _ ___.__ ..:.__ .._ ... . _ .��. .._ .- --- . _ ._. ._. __.� .� _ ._:- -�-�_. __ ., _ _ .�---.---�_� m
�--e---__ __�.._.__._._-..---. ___.__.________...___.._---- � - ..._.�.�.. ft --. _____.^___.___._.__._._.___�..._ -.-.�___�_._.___�..) W
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-_._...__.._..^._._.�______...._------- (tvPir,at)
�- r (mid Uy Intlltrator 5ystc;nis,bu:.) �
,�,,,,„�,.,„ 1U�ft bundlc�s � a0 il CISAhanil=�,,�,✓�it'
lnsl�ill pursuant lc�manufa�cturnPs fiistructfons.
�F ,�,.,,,,,_,,,,,,,_, ;�-ft t�undlcs @?_5 fil' F�ISAlunit=„�,_,�„ it'
__ _ _..__..___ ._ _..,._�.____._ _.__..._ _._.._.._ .---_._. _____._ .__
= I'rc,�-,��,crl L-JS/� p�r lrenr.h= ,��� fl' Required Irr(illr�3tion Area= .�,��� fl' Disirib��tic�n Mckhad:
x ,�,,,�„ trranches == �'rapc�se�l �1�ntal 1=1S1� _ .��. �t` ,�1'c�,,..�;,� �.,^��,�;���,f�
f�[=S FT �
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PAGE40F5
GRAVITY-DOSED -
SEPTIC / PUMP TANK SPECIFICATIONS
<-��e����
(No Scale)
>70 ft hom
Building Eleclri�al musl mmpty with
12'Min.or 20 ft a�ove SPS 316 and NEC 300
Established Flood Elevalion Weatheip�oof �nE manhole riser as ne�ssary.
(ry��l) Approvetl .luncfron Bon
Venl Cap Approved Lodcing Manhole
IMPORTANT: � wiihWam(ty�helAuatl�etl
I
Anchor hank(s)as necessary ���
pursuant to SPS 383.43(8)(g) 4'Min.or 2.0 ft above
Esla6lished Fbod Elevalian
(typical)
�Airtight Seal'.
Finished GraUe
Ouick Disconnect
78'Min.
CAPACITIES @��gaUn �..- �hw��>
Depth(i�) Volume(gal) a �
A ~ C� ()` -IIb•��* I WeeP `APProvedJoinfswith
� I F1ale Apprwed Pipe 3 fl anlo
B ^ 2.� fc� q Sdid Ground
�C� H 9� � �1,S.Z� � i cHv��n
� /l� ��c� � —��
B
}[c] � PUMP-OFF
* � Pump �_� ELEVATION= ft
Pump Tank Liquid Level= `%� in } �l• 5`l
I
° �„�,�� INSIDE BOTTOM
Force Main Diameter= 7 �� B� ELEVATION= c� s� ft
Foroe Main Length= �� O ft 3'AppmvedBeddirgMatenalBerreaMTank
Force Main Void Volume= l ,S� gal
[C]Total Dose Volume TDV =�� gal/dose � '�o
(<02X design flow+{prce main void volume)
VerticalLift= /2 .O " ft
PUMP TANK: SEPTIC TANK(S):
Volume=�gal Total Volume= /���J gaf
Manufacturer. G//;'r y_r� Manufacturer(s):�ri�.Ps F�=
Pump Manufacturer. �,o{,�/�
Install approved effluent filter at the septic tank outlet
Pump Model: l S 5 (�yattadiedpumpcurve.) immediately upstream of the�ump tank inlet
Controls/Alarm Manufacturer: s;3, ;C?�..�_�:r,_ Filter Manufacturer:_ �;'�� f-����
Controls/Alarm ModeL 7
Filter Model:���,� 2 2
Float switches containinq mercury are orohibited
� . .v� -r v� �
In-ground Dosed-Gravity Management Plan
IMPORTANT:
The owner of this in-ground dosed-grevity system shall be responsible for its perpetual operation and maintenance
pursuant to requirements of SPS 382384,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 acwrdance with this approved management
plan. Furthertnore, afi inspection and maintenance activities shalf be performed by a reyistered POWTS Maintafner in
accordance with SPS 383.52(3),Wisc.Admin. Code.
Maximum Dispersal Area Oaeratina Limits:
Design Flow= .�G�C� gpd; BODS 5 220 mgL''; TSS<_ 150 mgL''; FOG <_ 30 mgL''
Insoection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors(i.e. odors, user compiaints, etc.)
o mechanical maifunc6on(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 activRies, etcJ
o e�ent of ponding in distribu6on cell priorto dosing
o dosing irregularities-if applicable(i.e., pump re-cycling,float switch settings, etc.)
o electricai components-if appiicable(i.e.,wiring, connections, switches, controls, timers, alartns, etc.)
o distribution lateral or laterat orifice plugging (measure lateral distal pressure-compare to design specificationj
o surtace discharge of effluent or sewage back-up into structure served
Maintenance Checkiist MAINTAIN EVERY 3 YEARS (or when necessary)
o Seotic and dose tankfsl shall be pumped by a certfied septage servicing operator licensed u�der s. 281.48 Wis.
Stats.when the volume of solide in the tank(s)exceeds one-third ('l/3)the liquid volume of the tank(s)or
as required by locai ordinance. Disposai of contents shalf be pursuant to NR 113,Wisc. Admin.Code.
o EfFluent Flterlsl shall be inspected every 3 years and shall be Geaned when necessary to remove any
accumulated solids according to manufacturer's specffications. A servicing period will always be greater than 12
months.
Sys4em mai�te�ance reports shall be submitted to the proper local govemment unit In accordance wkh
SPS 383.55 Wisc.Admin. Code. RepoR any component failure or maifunction to:
Name ot individual or company: � Phone: /��7 sJ���Cl�
- _ _ -
Local govemment unit: Phone:���'"�;����
Loca! govemment unit address: �!� IP: � L.O�4�
Any defective part of this system shali be repaired, replaced, or removed pursuant to SPS 383.51 (1),Wisc.Admin.
Code. Repair or replacement of failed or mal4unctioning components shail compiy with SPS 383,Wisc.Admin.Code.
No prod�ct for chemical or physical restoration of ti5e POWiS may be�sed uniess 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 pian submitted to the appropriate agency for review and approvai. A failed in-ground dispersal component may be
abandoned and replaced by a code-comptying dispersai component in a pre-determined area of suitable soils.
Svstem Abandonment
if use of thi&PQWTS is dlscont�nued, it shall be abando�ed in accordance with SPS 383.33,Wisc. Admin.Code.
�
TOTAL DYNAMIC HEAD/FLOW
� w PUMP PERFORMANCE CURVE PER MINUTE
� MODEL 151/1521153 EFFLUENT AND DEWATERING
id 45 153
,z
40 MODEL 151 152 153
Feet Meters GaL Liters GaL Liters Gal. Liters
_ 'O 35 152 5 1.5 50 189 69 261 77 291
� � 10 3.0 45 170 61 231 70 265
¢ 75 4.6 38 144 53 201 61 231
0 8 25 151 20 6.1 29 110 44 167 52 197
� 25 7.6 16 61 34 129 42 159
� 6 2� 30 9.1 - - 23 87 33 125
35 10.7 - - - - 22 85
15 40 122 - " " - 11 42
a
�� Shul-off Head: 30 ft.(9.1m) 38 ft.(11.6m) 44 ft.(13.4m)
2 014508B
5
o Model 151 Models 1521153
10 20 30 40 50 60 70 SD � 100
GALLONS
LITERS 6 7f32 6�� �
0 40 80 120 760 200 240 280 320 3&0
37/8 45l8 3718 4518 � '
FLOW PER MINUTE
074508A
�
CONSULT FACTORY FOR 37�8 318
SPECIAL APPLICATIONS a —�- �, , �
� 3�,8 � �
•Timed dosing panels available e
• Electrical altemators, for duplex systems, are available and """�`
suppiied with an alarm � � � �
•Variable level control switches are available for controlling �
single phase systems �
• Double piggyback vanable level floa!switches are available i
for variable level long and short cycle controls
• Sealed Qwik-Box available for outdoor installations - See ,z,re �
FM1420 ,, ,,"� � � � —�
• Over 130°F (54°C) special quotation required � — I
s are
415/16 �
1511152/153 Series �4
s�
151H521153 MODELS Corrtrol Selection
Model Volts-Ph Mode Amps Simpiex Duplex
N151 115 1 Non 6.D 1 2 or 3
BN151 115 1 Auto 6.0 Induded 2 or3
E151 230 1 Non 3.2 1 2 or 3
BE151 230 1 Auto 32 Induded 2 or 3 „ „
N152 ��s 1 Non s.s � 20�3 Easyassembly
BN152 115 1 Auto 8.5 Induded 2 or 3 (pump&discharge pipe
not induded.)
E152 230 1 Non 4.3 1 2 or3
BE152 230 1 Auto 4.3 induded 2 or3
N153 715 1 Non 10.5 1 2 or3
BN153 115 1 Auto 10.5 inciuded 2 or 3
E153 230 1 Non 5.3 1 2 or 3
BE153 230 1 Auto 5.3 Induded 2 or 3
SELECTION GUIDE
1. Single piggyback variable level float switch or double piggyback variable level OPTIONAL PUMP STAND PIN 10-2421
float switch. Refer to FM0477. • Reduces potential clogging by debris
• Replaces rocks or bricks under the pump
2. See FM0712 for correct model of Electrical Altemator E-Pak. • Made of durable, noncofrosive ABS
3. Variable level control switch 10-0743 used as a control activator,specify duplex • RaiseS pUmp 2"off bottom Of basin
(3)or(4) float system. • Provides the ability to raise intake by adding sections of 1'/2"
or 2" PVC piping
ACAUTION • Attaches securely to pump
All installation of controls,protection devices and wiring should be done by a qualified • Accommodates sump, dewatering and effluent applications
lice�sed electrician.All electrical and safety codes should be fotbwed including the most NOTE: Make sure float is free from obstruction.
recent National Electrical Code(NEC)and the Occupationai Satety and Health Act(OSHA�.
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
O Copyright 2014 Zoeller Co. Alt rights reserved.
""'"'``=�� PRIVATE ONSITE WASTE TREATMENT county
.
���'�� � SYSTEMS
� � °$ Sawyer
, , p
��,-�� s_ ,.�; ( POWTS)
���� � ,;
\'A�F�.as�o.v %.i
� INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION 2� -- t� �
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. I 5.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village [�,Town of: State Pian Transaction ID#:
j�t c.�la�` ��e._q� l�ta(�� �'�.e..�� �
Insp BM Elev: BM Description: Parcel Tax No:
(00.c7� '-1� c��v.r�Q.,� I��O � �✓! "�� — ��-0�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic Benchmark (pp c, r
Dosing
Aeration Bldg. Sewer
Holding St I Ht Inlet
TANK SETBACK INFORMATION St I Ht Outlet
TANK TO P/L WELL BLDG vENr ro ROAD Dt Inlet
AIRINTAKE
Septic NA Dt Bottom �?o '
Dosing NA Instaliation
Contour
Aeration NA Header/Man. ���Q `
Holtling Dist.Pipe
PUMP 1 SIPHON INFORMATION Infiltrative �
Surface 19 S
Manufacturer Demand Final Grade
Model Number GPM isS �• ���•��
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFOR ATION
DIMENSIONS W 3' � o� o� #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate
P/L Bidg Well ❑ IGP ❑ Chamber
INFORMATION Waters � AG � EZFIow Motlel Number:
CELL TO �'.S 'CS?7 .r�_ <1�-� ❑ Mound o Other
--- __ --- ----
DISTRIBUTION SYSTEM X Pressure Systems Only
Header/Manifold — Distnbution Pi e s — — I X Hole Size X Hole Observation Pipes
[en th Dia Len th _ Dia S ac I Spacing ❑Yes ❑ No �
� P � )
g — 9 A — I'
SOIL COVER
___ __ __
Depth Over � Depth Over � Depth of � Seeded/Sodded � Muiched
Ceil Center Cell Edges j Topsoil 0 Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
� ��,5��� ��31��.�
�
� ���� ��� o� �
� � � r
- - ---� �
Plan revision required?�Yes❑ No �p3 � , �`'i� ��
;—�
' 1�3� ��_ - _-__ �
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A��ITI�NAL C�MMENTS AN� SKETCH
SANITARY PEFMIT NLIMBEA�.____ 7'�— 17(
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