HomeMy WebLinkAbout008-174-03-0700-SAN-2022-186 C.�
oFa'^�T"�.t\ Industry Services Division County �,.
v�y�: ♦
���� 4822 Madison Yards Way ��C� / - �
i,� ` _� � !� Madison,WI 53705 Sanitary Permit Number o be fille in by Co.
`�,,;,� � /� P.O. Box 7302 �
��H �--�^ Madison,WI 5302 (D �j � � �] �' �
���a�rav,:t 5�
I
V State Transaction Afumber �
Sanitary Permit Application �
In accordance with SPS 383.21(2),Wis.Adm.Code,submission ofthis 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 a dre ,g
the Departmen[of Safety and Professional Services.Personal information you provide may be used for secondary /yC+� `[J SG Gi $�, �f���� Lr K
purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. )
l.Applieation Information—Please Print All Information !�r�: ` ��'ry c_•c� .
Property Owner's Name � Pazcel#
C �� �� �-� � : £ ��-� ��� J L� y�� �_ c��� �'i�yc� 3c> >� �
Property Owner's ailing Address Property Location
�
73� F�f� �..���. ���v� �'��`� � � c�-�—,
City,State Zip Code Phone Number /
�a- ,�. , . S y ��.3 ��� _ .b.�t Section ! �
ll.Type of Building(check all that apply) Lot# � T-�l N R�E o��
�1 or 2 Famil y Dwellin g—Number ofBedrooms Subdivision Name
;SGc�SF t /���c ��
Block#
❑PublicJCommercial—Describe Use
� ❑City of
❑State Owned—Describe Use CSM Number ❑Village of
Q�Town of F 4C'-'[�/l.t ��'�
III.Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check ane box on line B.Complete line C if
a licable.)
`� ❑ New System �Replacement System ❑ Other Modification to Existing System(cxplain) �.� Additional Pretreatment Unit(explain)
B' ❑ Holding Tank �In-Ground ❑ At-Grade gn yp p )
❑ Mound ❑ Individual Site Desi ❑ Other T e(ex lain
(conventional)
C• ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued
Expiration oo _ia3� � 1� ��
IV.DispersaUTreatment Area and Tank Fnformation: 7,r
Design Flow(gpd) Design Soil Applicazion Rate(gpd/s� Dispersal Area R uired(sfl Dispersal Area Proposed(s� System Elevation r
6 oa � � � � � g � r o c�. .� — ��,.o'
Capaciry in Total #of Manu rer
Tank[nformation Gallons Gallons Units � � o � �
New Tanks E�tisting Tanks � o � � V � R �
0. U v� N v� u. C7 a,
Se tic HoldingTank � .-----_z (.y-t"fJ � �� L * C �'� � �
.r t' .
Dosin Chamber � `� �/ �� __.� � / �� , �� � �
V.Responsibility Statement- I,the undersigned,assame responsibility for installation of t6e POWTS shown an t6e attached plans.
Pl ber's Nam�(P�int) PIum4 s Signature MP/MPRS Number Business Phone Number
, �._._--.- , �
r �_ �` �/J- �
C , vli;�' . �c- r % � �- �_sx � -,136 .`�
Plumber's Address(Street,City,State,Zip Code)
,�-, ,�
.� ���� ��,��,. s,� . �;� �,��, �� �� s-y�� ��
VI.C u ty/Department Use Only
�A v�� ❑Disapproved Permit Fee Date Issued Issuing Agent Signature
�� ❑Owner Given Reason for Denial $�U�•�� g I S I�� �����li�.��c��t'����'�'
Conditi of Approval/Reasons for Disapproval p- _.
C� / � L � 1'1'� 'I��`P � �
�I�� ''�� �n�J-�-- ,
Date � .S a r� F � ' �- ' ;�
� So3�g ���;�� Jl�.�, � � ���� . -
� � Chk# -t �.
w � I���� � , � ��3 �
w�91 "�;C �l�.k�;��� l/�`.��.+ L�l_ _, __�
����d ----- _
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Attach to complete plans for the system and submit to the County only an paper not less thao 8 tn x I1 inches in size
NO REFJNDS AFTER
SBD-6398(R 02/22) ISSUE OF PERMI7
� $o S
• " PAGE 1 OF 5
��� In-Ground Dosed-Gravity Plan
�� tiotiti Index & Cover Sheet
0���'J ��� J��C�,�" Component Manual Design References:
�� ��05.��' In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
��sp��
c�P � Pg 1 of 5 Index & Cover Sheet
ti� 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
l�a<� �y
/ i
Owner Name(s): n/�.�.'r�c.Gl,r�� C £ l�'���e l�a��r°c� Phone: - -
Owner Address: 730fQ �./�uio fnF� G,�. E�a�< </c,���e . r.�,` Zip: S�i ��?�
Project Address: i`fOs sci�,s� f ,�eac l� ��,
Govt. Lot: 1/4 of 1/4, Section / 7 , T 37 N-R O E ❑or W�
Township: c���,cr- cfia f� ✓' County:
Project Parcel ID #: i�o � / 7 �/ C �3 D � b D
Designer Information
_�'
Designer Name: Qqc��.�� � ���r �1 � Phone: �/s' - 7 r�%- � i
DesignerAddress: .�?97�' �I�vSt Sr�. SG��o���� Zip: s�iR � 2,�
E-1'ilal�: l'�'1 �� 'f'C9 /�7 e.t��l� �/J '�' 1'� G i � r � C !�l �'�.•�a:c i �cd fu; ��r uvnl>tarnp.
License Number: �C 3 3 S � L1, 1
R@I118fkS: ' � ���� E-� L�uSC �t� �7� J2C� �'t�7 D �loC� _ �eb/ ��OGJt �7i � Nui�/7�.
�ki5
� � �
Signature: � , < �� � � Date: �S- 3 � ��
Original signature required on each s�itted copy.
CHECK BOX AS APPLICABIE. CHECK BOX AS APPLICABLE.
� SOIL EVALUATION Q Sca�e' �'0 4°' � � �. SYST�EM �PAGE 2 OF S
SITE MAP PLOT PLAN
PROJECT NAME:� �o, DESIC3N FLOW: 6� � � oa�
C � l^� � (/ G fn f {J_ Attach design flow calculations for commeroial plans.
PROJECT ADDflE33: / �I �� f V 5�:�.h s�-1• �eac � D�f� 1 Pipe Materlal ! ASTM Shandard (Tables 384.30-3& 384.30�5)
8M Symbd: � BM Elavation: 1��, � �- 'V Sanuary 3ewer. -r � �� �
L? (� Force Maln: �
8M Descriptton: T��5� E o � !'n w.Pa"• Pd �E. ��r�o g
Indkate rrorth by IMPORTANT:
siope Grad�ent(%) /1 �� yyell Symhol (if appilcable): Q drawinp en ertow Show ground e�evation contours at suifable frrtervals.
of Tested Aree: '7 /d on the app�oprlte Itrre.
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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 �NPI���
CROSS SECTION VIEW
,z„
m,�.,,e��h (No Scale)
depm
(NPlcel) . .
. a'a'
� �..
�ryP�`a�� , Provide minimum 3 ft
separation between trenches.
System Elevation=/��S ft
(typical)
Quick4 Standard-W
w!End Cap observatbn Plpe
(typical) (Show location of inlet/outlet pipe connection on plan view.) �NP�a�1 Typ�CAL TRENCH
Install per manWacNreYs
��s«�=��o�s. PLAN VIEW
i— —�f--------��----�is.� �a� -�
(No Scale)
4. _, * ��"�" a �I A=3.Oft
���_ � i#,'�'� i[r���t�l'Y�i�.�� (�YPlcap
__————��__—_—_—��_—_—_ ___—— �
� B s�OJ ft �-�l �
(typlcal) Quick4 Standard-W Chamber m
INSTALL PER TRENCH: �tyP���� �''�
(mfd by Infiltrator Systems,Inc.)
InstaA pursuant to manufacturafs instmcthns. �
02� Quick4 Std-W @ 20 ft'EISA/chamber= v vo ft� 'f7
+ � Pairs of end caps @ 6 ft'EISA/pair= _� ft� �
=Proposed EISA per trench= `�� � ft� Required Infiltration Area= '��ft� Distribution Method:
x � trenches =Proposed Total EISA= �'I�Z tt� �F�%�{i 2
�
' PAGE40F5
GRAVITY-DOSED
SEPTIC / PUMP TANK SPECIFICATIONS
(No Scale)
4"0 Venl Pipe
>10 ft from
Building Electncal musl cnmply with
12"Min.or 20 ft ahove SPS 316 and NEC 300
Establlshed Flood Elevauon E�ctend manhole dser as necessary.
(rypiral) `Neatherpmof
Approved Junction Box
Vent Cap P.PP��ed Locking Manhole
IMPORTANT: w;m wamtr,q�abe�auacned
Anchor tank(s)as necessary (�ypical)
� ��9� co�d�a
pursuant to SPS 383.43 8 n°M�n.o�z.o n abooe
Eslablished Flood Elevation
OYPical)
�Airtight5eal �
Flnished Grade
�uick�isconnect
18"Min.
CAPACITIES @� gal�n � . , «YP���1
: 4 1
Depth (in) Volume (gal) �
A ��' O ���(�, � � * � � WeeP �APProvedJolntswith
Hole Approved Plpe 3 ft onto
B Z,Q 3� A �'�I SoIldGround
(rypical)
�C� �, � � ��- � l V
_Alarm
� l0. /�o l� e I�—o�
� [c] PUMP-OFF
�k' � P°"'P �_orr EIEVATION = U. � 3 ft
Pump Tank Liquid Level =�in �
° INSIDE BOTTOM
Force Main Diameter = � in c°"`re`e
B�°°k ELEVATION = �C� � ft
�
Force Main Length = 7� ft 3"Appmved Bedding Matenal Beneath Tank
Force Main Void Volume = /�gal
[C] Total Dose Volume TDVZ = ';j/, � gal/dose
�
(<02X design flow+force main void volume)
Vertical Lift = ��q � ft
PUMP TANK: SEPTIC TANK(S):
Volume = 7S� gal Total Volume = � gal
Manufacturer. �l �r f—f [ c_i 7���C � Manufacturer(s): ������� ��c .
Pump Manufacturer: �� N �yP�^
Install approved effluent filter at the septic tank outlet
Pump Model: � � (See a�tached �mP��rve.� immediately uostream of the pump tank inlet.
Controls/Alarm Manufacturer: ��������� Filter Manufacturer. �'��� �U� O
Controls/Alarm ModeL• �_�0�/�5`07/ '
Filter ModeL• �% �� �az;�
Float switches containinq mercury are orohibited.
PAGESOF�'
In-ground Gravity Management Plan
IMPORTANT:
The owner of this in-ground gravity system shall be responsible for its perpetuai 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 considared a human health hazard if not maintained in accordance with this approved management plan.
Furthertnore, all inspection and maintenance activities shall be performed by a reglstered POWTS Maintainer in
accordance w(th SPS 383.52(3),Wisc.Admin. Code.
Maximum Disaersal Area Operatint� Limits:
Design Plow= � �� gpd; BODa 5 220 mgL''; TSS 5150 mgL''; FOG 5 30 mgL''
Insnection Checklist INSPECT EVERY 3 YEARS
o type of us9
o age of system
o nuisance factors(i.e. odors, user complaints, etc.j
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 d(stribution appurtenance(s) (i.e., distribution/drop boues)
o negiect or improper use (i.e., excaeding design capacities, prohibited activities, etc.)
o e�ent of ponding in distribution cell prior to dosing
o dosing irregularities-if applicabie(i.e., pump re-cyciing,float switch settings, etc.)
o etectrical components-if applicable(/.e.,wiring, connections, swltches, controis,timere,alarms, etc.)
o distribution lateral or Iaterai orifice plugging (measure lateral distal pressure—compare to design specificatlon)
o surface discharge of efftuant or sewage back-up into structure served
Maintenance Checkitst MAINTAIN EVERY 3 YEARS (or when necessary)
o Seotic and dose tank(sl shali be pumped by a certifled septage servfcing operator Iicensed under s. 281.48 Wis.
Stats.when the volume of solids tn the tank(s)exceeds onedhird(1/3)the Iiquid volume of the tank(s)or
as required by local ordinance. Disposal of contents shall be pursuaM 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 manufacturePs specifications. A servidng pariod will aiways be greater than 12
months.
System maintenance reports shall be submitted to the proper local govemment unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any eomponent failure or malfunction to:
Name of individual or company: 1�c c; „ ��..� S P v/i� �F s _Phone: ��S � -Z 3`Y - 7 9 E ;�
Localgovemmentunit: SGti:�yp� C�. zch,�� . Pno�: �T�s-63y - 8a�� .
Localgovemmentunitaddress: /0 6/O rYlry,y,,� S�, 'y `/9 ��cpyk;�q�6��C'�� 21P: S'/$'/j
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 physicai restoration of the POWTS may be used unless approved by the department in
accordance with SPS 384,Wisc.Admin. Code.
Continflencv 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-compiying dispersal component in a pre�eterrnined area of suitabie soils.
Svstem Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33,Wisc.Admin.Code.
�������� KEv eo��s �zc�e.�R �r� ---i�—. _- ,, s, �.�.�_.
BN - w! Ffoat fn Box '" ; , i " � ' -
R� �P S� M = Auto Float Attached (verticaE) �'� "` ,%'' ,��
N = Non-Auto (manual) � � �
E = 230V Non-Auto (manual) % -! PU/�ilP L"O.
"FLOW-MATE" 98 �QV,4L/TY/alfiN.PS �NCE IuQ�J � _
�� � � �� � � :
Z�+t98 �N38 9/2 HP 91�511 Autamatic Cast lron 1P2' Sc»fids, 1-312" Disc. Tethered Fioat {15'}
ZN98 1�1�8 1/? HP 11511 M�nuai C3st Iron 1I2" Sc+lids, 1-1I�" L4i�c.
._.. .......�...._
, �"Gfl � VfYGJ. �
The "Ffow-Mate" is constructed �FAD CA�AC4TY C11FlVE E
�, � � MODEI "98" 112 F{P � (
�,,�� �s�t98 of c6t,ratr�e cast �ron, carbon ' � :
�.�: cerarctic seais a�� a nnn-
. , . .s -_ ._ _ ____ _ , - ; __. _ . 4
clogging vortex impetler. �'
. 15' Cord � ' ' `
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APPltCAT10NS: ,s ----;- — =--_�__.._ _ ;._. _ .;—... _�,_._._..
- The °Flow-Mate" is ideal ior � , �
,.�.��,�� �'��� septic tanks, dosing, low � jo� , - _ _ =----� i
� ,� � �� . , u;,o . � ., t�ar� �curnis � 5 �
�.� � .� , , ,. �J�E'S8 ., r'Jtrlr {'S�
2 � ;
r ,�
� .� ;:� and step sy�iams -_ _. .__ _ -_ - � _�
,
- �� "~�..w`'� � , s
"� a : . , � -,
0 1C 2a .�'aj �Y� Sfl iX7 70 S�
'���''�`"'"'=^r;- PRIVATE ONSITE WASTE TREATMENT co��ty
;y�.�- �,.
=�����o$ SYSTEMS S aWyer
�.,� ps .� ( POWTS)
��k`,�--=.�;:ri
'�`x''��' INSPECTION REPORT Sanitary Permit No:
,,� �:.
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION ��r ���
Personal infonnation you provide may be used for secondary purposes[Privacy C.aw,s. 15.04(I)(m)]
Permit Holder's Name: ❑City ❑ Village �Town of: State Plan Transaction ID#:
G�,�,,� �-J�-�,..t,. llQhc 2 L:� e�., ,.._
Insp BM Elev: BM Description: Parcel Tax No:
(oJ.a� �� o� a..r�' �� � z7'3o�' OU� — I`��— 63�-07�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic }-�� s - )� Benchmark �,o/
Dosing _�� '7S'p
Aeration Bidg. Sewer 9 I.2�
Holtling St I Ht Inlet p,g �
TANK SETBACK INFORMATION St/Ht Outlet v�-7
TANK TO P/L WELL BLDG VENT TO ROAD Dt Inlet
AIR INTAKE
Septic a-$' t,��� S � d-S� NA Dt Bottom g�,,3 �
Installation
Dosing �� �� Y « NA Contour
Aeration NA Header/Man. ���, `
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infiltrative
Surface ���•-�I
Manufacturer �Q�� Demand Final Grade
Model Number �g GPM �=g� �°%'. la 1,$ �
TDH��, Lift Friction Loss Sys Head TDH Ft
Forcemain L �D � Dia " Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W � � � � #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv o Aggregate �� �
INFORMATION P/L Bidg Well Waters °� G � Chamber Model Number:
❑ EZFIow
CELL TO .y�' -F� (�'$ -} (6D ❑ Mound o Other Q 5,�
----- - --- - — --- — -- -
DISTRIBUTION SYSTEM X Pressure Systems Only
Hea�der I Manifold — Dist9bution Pipe(s) - P ' X Hole Si2e H eg Observation Pipe�
Len th Dia Len th Dia S ac S acin ❑Yes ❑No
SOIL COVER
--- - -- --- -- --- --- ---
( Depth Over Depth Over ' Depth of Seeded/Sodded Mulched
Celi Center Cell Edges Topsoil ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
� �.�1 l� ��--( �3 ���
I - -- - - -__ --
Plan revision required?�Yes � No �o �� �I� � � �
� �
, .
�—�� �__ _ _ - � ��� �J
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A��ITI�NAL COMMENTS ANO SK�TCH
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