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HomeMy WebLinkAbout020-638-04-5302-SAN-2022-271 :yc-_ IndustryServicesDivision ���Y � -�.` •¢�v 4822 Madison Yacds Way S�1✓ ''�/ � i:i���= - Madiso4�53705 Seni�eryP�tNumber(ahfilled'mby( , �: ; P.O.Box 7162 1J ��`%;�-�;ci�1 M8���4 WI 53707-7162 �o�� a.5 y 9J � '` " Sanitary Permit Applicarion ShteT�nnaectionN�unber � In accmdance with SPS 38321(2).ws.Adm.Code.submission of this folm to We appmpria[c govemmental wit � is requimd prior ro obteining e senimry pem�i[Note:Appliatim forma for statcowned POW'[S ve submittd to Project Address(if diffe[wt t6an mai'limg a — the DePertamt of SeCay md Rofeavnoal Savices.Pees�al infolmetion}w�Provide may be used for sxondery u�poses i¢accoed�ce with t6e Privecy Law,a 15.04(lxm),Stats. -7 j' � I. lintioeinformadon-PleasePrintAlllnformaben �OO!'� �,(./�5{pr1y �j�Ce � Ropeety O ' Neme Pa�wl# Cc q �l S I 0� L� C7 S3(7� r�nam ow��rs���ng naaress Pma��ti� e S �`� 3T� City.Stete Zip Code P6oae N�bc /�l C�:J� _ `-''C,(, �� S�"I / ��S'7Q �-O�S� ��Y•.5�.Ya Section� II.Type of Building c6eek aR tlut apply) �# T�3 R � E W �1or2FemilyDaeliing-NumberofBedmomc�_ � SubdiviaionNeme Blacic# '� �ublidComme}cial-Drscribe Use _ ity of teh Owned-DcxnbeUse CSM Nwnba illage of a-�/��1 �7� �r�or C')�T 1 bk/�t III.Type of POWTS Permi�(Check dthv"New"or"Heplaeement"and oMer appticabk on Hne A.Cheek one bo:on Bne B.Compleh line C e ticable. A. �lew Syshm �lacemeut SysOem ❑Dlha Modification to Exisung System(explain) Additional Pmueetmmt Unit(uplain) B' ❑Fiolding Tmk �7Uln-Growd O4t-Gende ❑Mound Individuel Sim Deai� Ot6er Type(uplain) w(conveotionaq C. �Renawal Before �Revition ge of Plw�ber ❑I'nnsferm New Own �oua Pamit Numba aod Dale iswcd Fapilntion IV.Dis ersal/1'reamient Area aud Tmk Informadon: Design Flow(�d) Desi�Soil Applicatim Rete(gpd/s� Dispe�l Area Requi'od(s� Ihspeisel Nea Pmposed(s� System Elevation ��( .� `1GO � (R,t.l 96.�-1d du 9,S.0 c,�ry m r� a or Mm�x� r�mt�u� ���o� c��� uo;n m� g 8 y; .� NroTmts EnitlingTmla �� y� � ,g� m n.U in i..U fi. SepticorHddingTaok X �1I7V1: 2 51-4 i� �4 f �a�8�h.��, � 2 4 O V.RespoueibWtr Statement-4 me ue�,aswme rapomibNry for imtaDatloo of the POWTS shown m t6e amched ploos. Plumber's Neme(Print) PI Si MP/A�$$N�wber Busioess P6one Number Cr� ��M � � � S�'1 �D�10 715-.�?�-;�.6�1v� Plumber's (Sheer,Ciry. aLe,ZiP Code) 5��3`J- �� �n �' � �l Lt/-� S`!�`1l� VI.C vn /Depa�tment We �A m ❑Disepproved P��t F� Dete Iawd Isauing A�ent Si�rtuee ❑OwnvCrivenReasonforDeoiel -(�.60 �I��.�I°73 ���1/L.� Conditions of ApprovaVReasons for Diseppmval � A A ����I�a �y�,��n� —�� ���IG1���=�, ���� _� __ � ���� � , CS`� ��—`�3� n�e,,N wa��a `�3cno�-� SEP 26 2022 = � ,.-- nmrn m c.ma�a�+�m�.y.m,ea.�eox ro ne co..ry o.ry w wnv ooe w.m..a�rs:tt�1R�Au��'I���',���,':�:.„:,.::::iJ 2o�l�a SBD-6398(R 03/21) NO REFUNDS AFTER ISSUE OF PEFiM1T , PAGE 1 OF 5 In-Ground Dosed-Gravity Plan Index & Cover Sheet Component Manual Design References: In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg 1 of 5 Index & Cover Sheet Pg 2 of 5 Plot Plan Pg 3 of 5 Dispersai 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): ��.�� l d- ��,/��_ sm ,-�-h Phone: 7/5 - ��3 - 415�_ Owner Address: �3� 1�wel 5`�. . S�� le.� , I.� J� Z�p: SL(��� Project Address: �-�lo�7 -1`� ��`s�eJ'R �r e�Z E'_ N� l S Govt. Lot: 3��{ _N� 1/4 of 5E 1/4, Section�_, T�N-R� (�E ❑or W � Township: ��i bW� County: � a ��/��' Project Parcel ID #: C�o�� �v � � b `i a�3� '�C Designer Information � / /�� Phone: 1S �� - :� ����� Designer Name: r�c � �_- Designer Address: ��v � -N � �,mPS�n �� (.t,��►n�,'�' Zip: �`1��� ���-�-�n��n I1c,p �. E-1'1'lal�: (, 1 L�e= ��1� 'I�!-zis s}-�z�cc rc�:�;aec; fc=t appru� �� ��,.�ni�>. License Number: ��� �1U Remarks: • ` s�`'I Date: � -�?�- Signature. � Original signature required on each submitted copy. CHECK BO%AS APPIICABLE CHECK 90X AS APP�ICA6LE. � SOIL EVALUATION o sca�e:��so' 75 � �SYSTEM PAGE 2 OF SITE MAP PLOT PLAN PROJECTNAME: oesicNF�av: �SU GPD 12.5' �rG Z�/ l�ors�. 1,G.k� Attach design flow calculations for commercial plans. � PROJECT ADDRESS: �G"JO�'N �,IJC j�'ffAJ �(PC� Pipe Ma[enal/ASTM S[andard(TaWes 384.30-3 8 384.30-5) N sa���rysewe� N" i (�1�✓/C BM Sjm�ol:� BM EleVa�ion: �D�•I U FT Farce Mairr ,��� / C'�l� BMDescription: �k'"� �I'� i f1 1��AP S'E.µALP sio ecrad�ient i mai�cenonney IMPORTANT: of Testetl Area:( � Well Symbd('rfapvlicable): Q arawing an armw Show ground elevation fAntours a�sui�dWe intervals. on the approp�Re lirie. � \ �(J YlC'�I \ �� � � � \ �1'�-� \ � � � \ s � � ) `�,e^�,��'µa � � �r� NT \ ���'� l' � � U a^�ore9�^ci.1 \ Z � � � � r 1 � � � 1 � i � '��� � � \ N v � �-/ �j1�0 r1�J IN-GROUND DOSED-GRAVITY DISPERSAL AREA Uniform Elevation Trenches with EZ1203HP Bundles 3-ft Trench (down-sizing credit) � �' V� I min.12' ��°re'�'� I c�va��n TYPICAL TRENCH cover SOILCOVER CROSS SECTION VIEW +z• T (No Scale) OBSERVATION PIPE DETAIL min.trench� � : . deplh L I (No Scale) (�Pj��) — — ��f`; Screw-Typa or Fniehetl Grede slip cev(�ooea) (mulchea s saedatl) /Tq s /S�G �� 4"0 PVC Pi Topwil Cover S stem Elevation= ft. � .� . y �ryPi��� Provideminimum3ft iapotv�aeb���nete (min.itooq at or above finrshetl grz0e separation between trenches. (4)1/4'-1 X 6"Sble � apah TYPICAL TRENCH (Show location of inlet/outlet pipe connection on plan view.) n�u,on�9��;� i�nn�p� SuAace PLAN VIEW (No Scale) 4..� ObservationpiPeshallbeinelalled a��,�ai��ee+wee�nvo u�its. Perforated Lateral Observation Pipe ft — (typical) (bviwq — — (bP�cap �'f- - - - - - - - - - - - - - �� � - - - - - - - - - - � 1 =_____ _______ ::---: ___ _______ ______" I A = 3.0 ft D � - - - - - - - - - - - - - �� - - - - - - - - - - - - - - - - - - - J c�vv���> G� g = � ft �I m (bp�0 w INSTALL PER TRENCH: EZ120yPcB�ndle � � 10-ft bundles @ 50 f� EISA/unit= aS0 ft' (mfd by Infiltrator Systems, Inc.) (n �� Install pursuant to manufacturer's insWctions. + � 5-ft bundles @ 25 ft EISA/unit= ft' = Proposed EISA per trench= aS0 ft` Required Infiltration Area= � ft� Distribution Method: x � trenches = Proposed Total EISA= � n' l i"('cw����/ � PAGE 4 OF 5 GRAVITY-DOSED SEPTIC / PUMP TANK SPECIFICATIONS (No Scale) 4"0 Ven1 Pipe >70 fl hom Building ElecMcal must comply vnlh 12"Min,or2Aflabwe SP5316andNEC300 Established Flood Elevalion Weatheqxoof E#end manhole nser as necessary. (hPi�l) Approved Junction Box Vent Cap APProved Locking Manhole IMPORTANT: w�cn wam��9�abei Aaa�,ed (ryplcap Anchor tank(s)as necessary ���a��� pursuant to SPS 383.43(8)(g) a^nnin.or zo n above Established Flood Eleva�ion (rypicap �AiRighl Seal Finished Grade � �uick Disconned 18'Min. CAPACITIES @ ��o.y 7 gal/in Y , . �NP'�'� - • a I Depth(in) Volume(gal) A fC/ ,I —�cT Q.� �C��7.�� I W�P '�APProved Join�s wilh Hole Appmved Pipe 3 fl onto B 2,0 � qL+ p. Solid Ground MPinq [C] 6.5 Ic;)_0 � [�'7 / Alartn D I� '_1 /�4+LI B �—On � �� PUMP-0FF / *Pump Tank Liquid Level =��in � �mP —�" ELEVATION = �v�P.Q ft �1�� � cancrete INSIDE BOTTOM Force Main Diameter = cx in Bi� ELEVATION = �5_C ft Force Main Length = �� ft 3"ApprovedBeddingMaledalBerieathTank Force Main Void Volume = �.�0 gal (C] Total Dose Volume TDV = � gal/dose � (<0.2X design flow+force main void volume) Vertical Lift=�_ft PUMP TANK: SEPTIC TANK(S): Volume = �� gai Total Volume = 1p3`7 gai Manufacturer. ��u�+J 1'f� l.,«5t Manufacturer(s): / �� e �`�5� Pump Manufacturer: �o� ��S _ Insiail approved effluent filter at the seqtic tank outlet PumpModeL 7t sl ($eyatladiedpumpcurve.) immediatelyu�streamofthepumotankinlet. Controls/AlarmManufacturer. T�� iql-e`t FilterManufacturer. I'`1�51� Controls/Alarm Model: / D � y� Filter Model: �'i�T �n—� Float switches containinq mercury are prohibited PAGE40F� 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 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 Disoersal Area Ooeratina Limits: Design Flow= �s(7 gpd; BODS <_ 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 tankls)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 (113)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 Geaned 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: �� 1 n��l� d- JoftS �y�- Phone: �7I S- oZG� �45��� Locafgovernmentunit: �ar,1YEr �U��1`�Y �O��n`� Phone: 7lS'(�34'�c2S�� ✓� � / Local government unit address: 1��G7. I �14:� 5�_ 5u�'�Z �(�( �5!/ax+��< ZIP: s`�z�5��3 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 matfunctioning 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 approvai. 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. • � � , � � � � � � f � Wastewater - � METERS FEET 40 ---,r ._ � �._, _ _. . � _.. . __._ - __,__ __ w...._ _�.-_�.. . .,. _ - - -__ _.- -- ---,_._ __ __ _ _ _. - - - MODELS• PE5't _:_ _=_ � _, ; . # -- - ---- .. _ .. ._ <. , : ; -- __-_:---- } - -- — - - ; PE31, PE41, PE51 : - __ __ _ - ' -;-- .: .� _� .�_. : . _ _ ; _ '. i- - ' HP. .33. .40, .50 35 ' , - _� - __.:__ _, �_�. _:. .,. ___.._. . „�,�..,___ : � . wra � __. : - � -- - � ' ; _ � 10 �. -- - . _ -- ; i . _ —► 2 GPM ' ; , - - -�- ----,- ,-- �l-- -; - ------ -� - - - - - _ - . �. --�-- - - - ----� ;-� 3 30 . ' ` �� : w::� �:� .< , , , - - �-� - --- ,_.__ , ....',. _ __ _. 1 FT _! ; --+ _.. . ___:> > . . - : G ; ; ; . _ ;. _ . - , - --- -�-i {__--_ Q -- -� - = - - - - - - - - � .. _. 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' '• 0 10 20 30 40 50 60 70 Gpry� 80 � � i � 0 5 10 15 m3/h caPaunr PERFORMANCE RATINGS PE31 PE41 PE51 Total Head Total Head Totai Head (feet of water) �'PM (feet of water) GPM (feet of water) GPM S 52 8 61 10 67 10 42 10 57 15 59 15 29 15 46 20 50 20 16 20 33 25 39 25 p 25 16 30 26 35 8 � Effluent5 ��'"''"T"""`:%>_.y_ PRIVATE ONSITE WASTE TREATMENT county ��t%< o$ `���; SYSTEMS Sa,W , `���� Ps ��� ( POWTS) yer �� � ,�� �`�ss,"�`:`'i INSPECTION REPORT sa�itary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION 2� ,-a?� Personal infonnation you provide may bc used for secondary purposes[Privacy Law,s. 15.04(1)(m)J Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#: �u,�� d �Ma �q s�<<4�. �^��,,,,�q Insp BM Elev: BM Description: Parcel Tax No: ��.� � Ga �o�� �.. �� � o��G38-o�r- s-3aa TANK INFOR TION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic ��- (�p Benchmark /oo,� ' Dosing —U,r•�� bco Aeration Bldg. Sewer � ' Holding St/Ht Inlet y;(� ' TANK SETBACK INFORMATION St/Ht outlet �,g � TANK TO P/L WELL BLDG vErvTro ROAD Dt Inlet AIR INTAKE Septic 3"�' �.�� 1l/ �/ NA Dt Bottom $/•g,�` Dosing �^ �� �, a NA Installation Contour Aeration NA Header/Man. �S,g � Holding Dist. Pipe PUMP 151PHON INFORMATION Infiltrative � o � Surface �• Manufacturer sy f Demand Final Grade Modei Number � � GPM TDH /y Lift Friction Loss Sys Head TDH Ft Forcemain L ��c��' Dia � �` Dist.To Well DISPERSAL CELL INFORMATION DIMENSIONS W 3 L ' �' � �' #of Celis Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav � Conv ❑ Aggregate INFORMATION P I L Bldg Well Waters � IGP ❑ Chamber ❑ AG Qc EZFIow Model Number: CELL TO �-� �(vo� �-apo �l'(� ❑ Mound o Other --_---- - --- -- -- - ---- DISTRIBUTION SYSTEM X Pressure Systems Only _ __- -- - —- - T Header/Manifold Distribution Pipe(s) i X Hole Size X Hole Observation Pipes Length Dia Length Dia Spac i Spacing ❑Yes ❑ No � --- - -- SOIL COVER -- - — --- - De th Over De th Over De th of Seedetl/Sodded Mulched Cell Center Cel�l Edges � Topsoil � ❑ Yes ❑ No ( ❑Yes ❑ �� -- __-- - COMMENTS: (Include code discrepancies, persons present,etc.) �����1 �1�� ) a3 Plan revision required?�Yes ❑ No - /� � �OD� � 'S� a2`( � --- �/ _ � 6`� � « Use other sitle for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) A�OITIONAL C�MMENTS ANO SKETCH SANITARY PERMIT NUMBEA: aa--��I C�c� �.>� Lw�� �„"� 'P`l� . . .__ .__. ; _ : , k�� _ _ ; ' _ . . , � , � ; __- G� � �--� v� � _._ , . , ._ ._ � � k, _ _. . � 8��- � � `. _ _ r _ �� � v°�'�k �n�1' � � 0 �� _ ` _+3°' �I 4�� Q� � 3 , � � ..��� �`� ��� � � `���� u��� , ������' P��`' � �u,��� �`��� ? � `�r�S p' ` c � � �o��' �— � �fo w����