HomeMy WebLinkAbout010-941-14-4301-SAN-2022-293 � . .
!:�"-=�9�"-:.A industry Services Di��ision County ��� �
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; 48?Z Madison Yards Way �G1 w � Y- �
��:! �,�5 p - Madison,WT 53705 Sanitary Permit Nu ber(to be filled in b
� �� _ - P.O.Box 7302 �
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���x'� -;�; Madison,WT 53707 3 �
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Sanitary Permit Application Statc Transaction Number �
In accordance with SPS iR3.21(2),Wis.Adm.Code,submi,sion of this foim to the appropriate�oeemmen[al uni[ _— �
is required prior to obtaining a sanitary permit.Note:Application fbmis for statc-owncd POWTS are submittcd to Project Address(if dift'erent than mailine VJ
the Department of'Safety and Professional Services.Personal intormation you provide may be used for secondary
purposes in accordance widi the Privacy Law,s. 15.04�1)(m),Stats. SZ,��j w ��j `'��( Q�'�
I.Application information-Please Print All information
Propccty Owncr's Namc Parccl#
�� L a.� �, L L.C, p � o -- �i 4 (— f 4- y 3 o I
Aroperty Owncr's Mailing Address Pmperty I.ocation
I o 5 61 ►•1 �' C3�;�.� (�-:!( (Z�. ��.�L�.��- _
Ciry,State "I_ip Codc Phone Number
��Q (,C�Qh d W l S 10 l3 (O�G.- -7�Z -6�JC1 � -���., 5� '/,, Section � �7
II.Type of Building(check all that apply) Loe# ,\ T �E� N R E o W
�I or2FamilyDwelling-NumberofBedruoms�__ SubdivisionName
Block n
❑PubliclCommercial-Describe Use �
❑City of
❑State Owmed-Describe Use CSM Number � illage of
�To�,�f 4�r w�v-
iII.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 �Iew System �Replacemen[System ❑Other Modification to Existin�System(explain) �Additional Pretreatment Unit(explain)
B' ❑fTolding Tank �fn-Ground �1t-G�ade �Mound Individual Site Design Other Type(explain)
(com�entional)
C. �Renewal Before �Revision �Change of Plumber �fransfer to New Owner List Previous Permit Number and Date Issued
Expira[ion �� ^O ^ ��� 2 �
o'�
IV.Dispersal/Treatment Area and Tank Information:
Design Flow(gpd) Desi�n Soil Applica[ion Ratc(gpd/sfj Dispersal Area Required(sf) Ui,persal Arca Proposed(s� System Elevation
(�U� 8S8 I �� �S'IS �
Cap�city in Total �l of Manufacturcr
Tank Tnformation Gallons Gallons Units � � o � _
Ncw Tanks Esistin�Tanks �` � � � �-y � � �
0
a U in � vi i; C7 G,
Scptic or Holding Tank �Z� f '
t7
Dosing Chamhcr d61� � �
�Ll
V.Responsibility Statement-1,thc undersigned,assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name(Vrint) Plum er��'�, turc �__� MP/MPRS Number Business Phone Number
Ro D ���c�r Ce �// ! '---- L'Zlo Z.I�j "1 I S- .��i-�'j - bSC 3(�
Plumbers Address(Street,City,State,Zip Code)
L 4S 11 U-a 5-�- � ��Z }-}� t��r c� [.t�( �'-t�`f�
VI.County/Department Use Only
�A r e ❑Disapproved pennit Fec Date issued issuin�A�ent Signature
32pp,�- -�j/]
` ❑Owncr Givcn Rcason for Dcnial � �( (� I�� ' 'I
Conditions of Approval%Reasons for Disapproval
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A[tach[o complete plans tm•the system and submi[[o the Counh�only on paper not less than S US ,1��' �n gizC . � - �� �
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SBD-6398(R.02/22) i1Q t�Ft1NDS AFTER I �o� �
I�SUE OF PERMIT
PAGE 1 OF J�
In-Ground Dosed-Gravity Plan
Index & Cover Sheet
Component Manual Design References:
Version �, SBD-10705-P (N.01/01, R. 10/12)� ,,
Pg 1 of �] � ` Index & Cover Sheet
Pg 2 of 7' Plot Plan
Pg 3 of �j Dispersal Area Cross-Section & Plan View
Pg 4 of 7 Pump Tank Specifications
Pg 7 of �7 Management Plan
Attachments: Enclosures:
Pump Curve �' `7 POWTS Application for Review
� � �L~ � �, Soil Evaluation Report & Site Map
Project Name / Description
Owner Name(s): � 3 �-�-� � L I,e. Phone: boZ - �OZ - 6 3q 1
Owner Address: l �5 6 L I�1 d` $��c.,� L-���( �� Zip:�a.�,w�r� �.c�l S�t843
Project Address: ISZS'g l,� �dsP,'��( �Z-� [-��.ti ���� ,, (�t S4��3
Govt. Lot: S �c.) _1/4 of S� 1/4, Section l y , T��N-R (�� E ❑or W�
Township: ��, W c�v� 1L County: s�w� ��-
Project Parcel ID #: O I a --- �'-f� ( ._.. 1 �-{ — �3 O (
Designer Information
Designer Name: �Co 6 (,��h�,r�'� Phone: —[1S- 6�C�C - O� 3(0
Designer Address: (�45'! 1 �,1 5-�- �}-w�, ZZ �wQr•d (.c�(Zip: 5��843
E-maiL•
License Number: Z Z�p Zl�
Remarks:
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Signature: ti ` � Date: ��' �
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IN-GR�UND DOSED-GRAVITY DISPERSAL AREA
Stepped Elevation Trenches with EZ1203HP Bundles
3-ft Trench (down-sizing credit)
� min.12"
����eXf��� � �ry����> TYPICAL TRENCH
c°�P`_ CROSS SECTION VIEW Provide minimum 3ft
soi�rovFa separation between trenches.
_ ,Z. (No Scale)
min.irench � o '
dB��n L — — — �
��YPical) � �
Highest Trench Lowest Trench(as applicable) OBSERVATION PIPE DETAIL
(No irale)
- Sr.rew-Type or •,�, ,. 1=inishod Grade
System Elevations= q S;1 S ft� Q S�1 S {t; q�•—I 5 ft; 4�•1S ft; ft Slip Cap(looso) . •W � �
' mulched 8 seeded
'` To soil Cover
4"0 PVC PiPe ,� min 1 toot) I�
Top of�l�fo�arr,�inale ( ' . i
atorabbVo ni edgrade �
TYPI CAL TRENCH (Show location of inlet I outlet pipe connection on plan view.) �a>>�n��-vz•�x s°sio�,
PLAN VIEW '' ` �
Anchonng Device In(iltra�ron �
(No Scale) 4n� Observalionplpeshallbeinstalled Surface
at junclion belween two uni�s. ft
Perforated Lateral Observatlon Plpe �ty�i�ap
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INSTALL PER TRENCFi: (typical)
✓"� 10-ft bundles @ 50 f� EISA/unit= Z.�S� ft2 (rnfd by Infiltrator Systems,Inc.)
Install pursuant to manufacturer's instructions.
+ 5-ft bundles @ 25 fl' EISA/unit= ftI
= Proposed EISA per trench= �sQ ftZ Required Infiltration Area= �� ftZ Dislribution Method:
x � trenches = Proposed Total EISA = l D�b ft2 P_r"'���GT���7 -�
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Paae 4 Of f
S�PTIC TANK � PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
4" CI VENT PIPE 12" MIN . ABOVE GRp.DE � WEATHERPROOF
? 25 ' FROM DOOR , WINDOW OR JUNCTZOr1 BOX APPROVED
FRESH AIR ZNTAKE ti�ITH CONDUIT MANHOLE COVE
W/ PA�LOCK �
FINISHED GRADE WARNIN� LABE
4" CI RISER �
y �--4 " MIN .
18 " I Id . 6" MAX . f:*
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INLET � � -
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WATER TIGHT SEALS GAS- , '
� TIGHT � �� vAPPROVED
q SEAL � �, JOINTS WITH
APPROVED ---�— � ; ALM APPROVED PIPE
PIPE 3' —�-- � '� ON 3' ONTO
ONTO SOLIO SOLID SOIL
SOIL � C � �
PUMP OFF ELEV . i . FT . —�-- pFi '`� RISER EX
D PERMIT'?'ED G
IF TANK
MANUFACTUR�
HAS APPROV�
3" APPROVED BEDDING UNDER TANK
CONCRETE PAD
SPECIFICATIONS
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S�PTZC / DOSE � `` "-^ �
TANK MANUFACT"JR�R : R���� S'E �' NUNB�R DOSES PER �AY :
TANK SIZES : SEPTIC "Z.OQ GAL. DOSE VOLUME INCLliDIN�
DOSE -��� GAL . FLOWBACK: �� GAL. -
AL.ARM MANUFACTURER: �„�" �;� CAPACITIES: A = �7�INCHES = �37. � GA
MODEL NUMBER:
SWITCH TYPE: F p,/�t B = 2 ZNCHES = ��GA
?UMP ?�IP.NUFACTURER : ��p C = �� � INCHES = t�fS<� P
MODEL NUMBER : 8 - 7�9
SWITCH 'I'YPE: D = INCHES t Z��
REQUIRED DISCHARGE RATE �� GPM PUMP � ALARM WIRIN� AS PER ILHR 16.23 F
VERTICAL DIFFERENCE BETWEEN PUM? OFF AND DISTRIBUTION PIPE . . ,"�S FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . . 2 . 5 FEET
+ �_ FEET FORCEMAIN X �FT/100 FT. FRICTION FACTOR . . .''f FEET
T.OTAL DYNAMIC HEAD = F�ET
IhTERNAL DIM�NSIONS OF PUMP TANK: LENGTH bC� ; WIDTH ��S ; DIAMETER `�
LiQUID �TH-�_,
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PAGE �OF7
In-ground Gravity Management Plan
IMPORTANT:
The owr,er or:his ir-ground graviry system shali be resoonsible for its perpetual operation and maintenance pursuant to
reGuireroents of SPS 382-384,Wsc. Admin. Code. Pursuant to SPS 383.52 (2), VUisc. Admin. Code, this system shall
be considered a humar, Fealtr hazard i`not maintained in accordance with this 2pproved management plan.
Furthermore, all inspection and mainteoance ac:ivities shail be performed by a registered POWTS Maintainer in �
accordance with SFS 383.52 (3),Wisc. Admin. Code.
Maximum Dispersal Area Oaeretinct Limits:
Design Flow= �o DD gpd; BODS<_ 220 mgL-'; TSS <_ 150 mgL''; FOG <_ 30 mgL-'
Inspection Checklist lNSPECT EVERY 3 YEARS
c type of use
c age of system
c nuis�nce factors (i.e. odors, user complaints, etc.)
o mechanlcal malfunctior (i.e., pumps, vaives, switcnes, floats, etc.)
c material fatigue (;.e., ieaks, breaks, corrosion. etc.J
o solids volume in anaerobic trea[ment tank(s) and any distribution appurtenance(s) (i.e., distn5ution!drop boxes)
c neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.)
c extent of ponding in distnbution cell prior to dosing
c dosing irregularities- if applicable (r.e., pump re-cycling, float switch settirgs, etc.)
c electrical components- if applicable(i.e., wiring, connections, switches, controls, timers, alarms, etc.)
c distributior. iateral or lateral onfce p�ugging (measure Iateral distal pressure-compare to design specification)
c surface discharge of eff!uent or sewage back-up into structure served
Maintenance Checklist MAINTAlN EVERY 3 YEARS (or when necessary)
o Septic and dose tankls)shali be pomped by a ceRified septage servicing operator licensed under s. 281.48 Wis.
Stats. when the volume of soiids in the tank(s) exceeds one-third (1/3)the liquid volume of the tank(s) or
as required by iocal ordinznce. Disposal of cortents shall be pursuart to NR 113,Wisc. Admin. Code.
c Effluent filter(s1 shal; be inspected every 3 years and shall be deaned when necessary to remove any
accumulatee solids according to manufzcturer's specificatior.s. A servicing oeriod will always be greater thar 12
mcnths.
System maintenance reports shall be submitted to the praper local government unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to:
Name o!ir.dividua! or company: RO }� (^� b�.rc� � � �q Phene: 1�� -bsS- b�Z 3 �O
Loc21 goverrmen! ur.it: .54.W�tr �o �O✓i �.�G Phone: �IS-634 .SSZgg_
Local goverrment unit zddress: 1 0 ��� t✓�,ci�r S-[ � ��1 I-{-Q�w�rd (,e.�iP: S�tFs�t3 _
Ar.y defective part of this sys:em shall oe repaired, replaced, or removed pursuant to SPS 383.51 (1),Wisc.Admin.
Code. Repair or replacement of f2iled or malfunctioning componer.ts shall comply witn SPS 383,Wisc. Admin. Code.
No oroduct for chemical or physical restoration of the POWTS m2y be used uoless aporoved by the department in
accordance with SPS 384, Wisa Admin. Code.
Continqencv Plan
In the event that any railed treztment componen?cf this POWTS cannot be repaired, it shail be replaced pursuant to
a plan submitted to tre appropriate ager.cy�or review and approval. A failed in-ground dispersal component may be
abandoned and repizced by a ccde-cempiyirg dispersal comooner,:ir a pre-determired arez of suitable soils.
Svstem Abandorment
If use of:his POWTS is discontinued, i:shal! be abandor,ed in accordarce witF SPS 383.33, Wisc. Admin. Code.
�/;`%''"'-"'f'=`';.,r\ PRIVATE ONSITE WASl'E TREATMENT �ounty
,��� ? o�;p � �w� SYSTEMS Sa,W er
�"� �� s� �'� ( POWTSj Y
:�\�--�=/
°`i's51='�`'' INSPECTI4N REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION oZ�,_ ��3
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village � Town of: State Plan Transaction ID#:
� �►� �.�L q ,�,�� �
Insp BM Elev: BM Description: Parcel Tax No:
��.� � ��.� ���— 9Yl_ ,Y_ �3��
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �,,��f-^ (ao� Benchmark �oa.o`
Dosing .-�.bo g�o
Aeration Bldg. Sewer q���
Holding St/Ht Inlet q$:qb '
TANK SETBACK INFORMATION St/Ht Outlet 9S7,Z,'
TANK TO P/L WEL� BLDG VENT TO ROAD Dt Inlet
AIR INTAKE
Septic �1oc` 3?` ��{` .��y ` NA Dt Bottom �'�,�'�
Dosing « « « « NA fnstallation
Contour
Aeration NA Header(Man. �,,Yb`
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Inflltrative ,
Surface qs•�S
Manufacturer (�. Demand Final Grade
Model Number �� (S� GPM 1'���� ��= Y'7, Y�
0
TDH � Lift Friction Loss Sys Head TDH Ft
Forcemain L �y ` Dia a`� Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W 3 L � � � �' #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav Conv ❑ Aggregate
INFORMATION P I L Bldg Well Waters � IGP ❑ Chamber
❑ AG g� EZFIow Model Number:
CELLTO �-�oo` �'(oD� �'(S�� N ❑ Mound o Other
DISTRIBUTION SYSTEM X Pressure Systems Only
Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes
Length Dia Length Dia Spac Spacing ❑Yes ❑ No�
SOIL COVER
Depth Over Depth Over Depth of Seeded/Sodded Mulched
Cell Center CeII Edges � Topsod � ❑Yes ❑ No ❑Yes ❑ N�
COMMENTS: (Include code discrepancies,persons present,etc.)
��.s�(Iru� �b� 3� � �2
Plan revision required?�Yes❑ No �3 �� �3 � , / ���� �
—�
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A��ITIONAL C�MMENTS ANO SKETCH
SANITAAY PEAMIT NUMBEA: �-� -2 9�
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