HomeMy WebLinkAbout024-641-14-4406-SAN-2022-319 r
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`'-�t�' Indust�y Services Division Countv (�
� 48?2�-fadison Yards W<.�- �c�t,� .e� �
= .�SP � Madison,Wi 53705 Sanitary Pcnnit 'umber(to be filled in by C �
� = P.O.Rox 730?
�'h''` ,,'��` Madison,Wi 53707 �p 3� ��U� �
,.«�.;,.;:
Sta[e Transaction Number �
Sanitary Permit Application � �
In accordance with SPS 3R3.21�2),Wis.Adm.Code,submission oPthis fa�n to the appropriate�overnmental uni[ w
is rcquircd prior to ohtaining a sanitary perniit.�Iotc:.4pplica[ion furnis for statc-owncd POWTS are submittcd to Project Address(if difterent than mailing ac �,�
the Department of'Satety and Professional Senices.Pcrsunal infi�nnation you provide may be used tor secondaiy
purposes in accordancc with the Privacy Law,,. 15.04(1)(m),Stats. ,7��� M oo� Ll� 1��
i.Application information—Please Print All Tnformation �
Property Owncr's Namc Parccl#
�e� D. � e �he- . ��(Se�r ��' OZ�-I— 64��— 14— �L40(o
Property Owner's Mailing A css Property Location
N 9�o n� ' I R�
� c,ovt.Loc
City,State "l_ip Codc Phonc Numbcr
J �7L�. (� � 535Jv \�C '., NE '/,. Section�
ii.Type of Building(check all that apply) L��'� T �"� N R O 6 E o
�( I or 2 Family Dwelling-Numberoi'Bedruoms � 1 Subdivision Name
�W
Block r �
�ublic/Commercial-Describe Use
❑Ciry of _
❑State Owned-Describe Use CSM Number Village of
10�3D6 � 2 2-`�c� �'ra,�,�r- Ro�� � La� 2
iII.Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.Compiete line C if
a licable.
A' �Vew System �Replacemen[System ❑O[her Modification to F,xisting System(explain) �Additional Preh�eatmen[Unit(explain)
�--t
B' �Holding Tank �In-Ground �t-G�adc �Mound Individual Site Design Other Type(explain)
(com�entional)
C. �Renewal Betore �Revision ❑Change of Plumber �1'ransfer to New Owner List Previous Pem�it Number and Date lssued
Expiration �
�h
IV.Dispersal/Treatment Area and Tank Information:
Design Flow(gpd) Design Soil Applica[iun Rate(�_pcUsf j Dispersal Area Required(sl) Dispersal Area Proposed(sf) System Elevation
�Sa ,"1 b�f3 (�9z � 9z . S�
Capacity in Total i�of Manufacturcr
�
Tank Tnforma[ion Gallons Gallons Units � o '� u
� � � N
Ncu�Tank� Existing Tanks '� � y � y � � �
a U rn v, v: i; Ci a.
ScpticorHoldingTank 100p ,�D �, ��6('� Z �,,cJl G$C�
Dosing Chambcr /„O 606 I �� � �
f�V
V.Responsibility Statement- I,the undersigned,assume responsibility far installadon of the POWTS shown on the attached plans.
Vlumber's Name(Print) Plu c s i,naturc MP/MPRS Number Business Phone Nttmber
Rob L�.b�cce `=�� z-zezlg -r��_ 6�_ 0�3�
Plumber's Address(Street,Ciry.State,Zip Code)
��s�� � s't� '�lt-� �� ��'i L.c�4.lr� 1.2.� � .S'GB�
VI.C untv/Department Use Only
�A�o o g Pennit Fec Date T;suzd Issuing Agent Signamre
9 ❑Disapproved
� �� ❑O�c'ncr Givcn Rcason for Dcnial S���� i U I 7� I �`� �%t��7 J�""�
Conditions of ApprovaUReasons for Disapprovai ,
r-^�_'�
t �._ -� !,���
�:��� � � .3� �-� �_ _ �; �,,' � i',;,��1
� a 2�, � , , ,�, , 1 _ , ___. , ��
��� IN� � _�.n ., � .. ��--- �� -�=-�, ��,
cnk# - ���. ��
±��r�t# N�w w� �� �`f oe��_`..� OCT 2 6 2022 )
C ST��� �2�UU> � �'��
SAWYcR COUNTY }
A[tach to complete plans Pm•the system and submi[to the Counh�only on paper not tess than R V2 x z ^ � �C I
d J
sBD-639s�R.ozn_�� N�fi,�FUNDS AFTER
I�SUCOF PERMt7
PAGE 1 OF J
In-Ground Dosed-Gravity Plan
Index � Cover Sheet
Component Manua/Design Refe�ences:
In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
Pg 1 of 7 Index&Cover Sheet
Pg 2 of 7 Plot Plan
Pg 3 Of 7 Dispersal Area Cross-Section 8�Plan View
Pg 4 of 7 Pump Tank Specifications
Pg 7of � Management Plan
Attachments: Enclosures:
Pump Curve .S � POWTS Application for Review
Sr er �N'Fo b `7 Soil Evaluation Report&Site Map
Project Name/Description
Owner Name(s): �'\e r� �, ��!SC r �'� Phone: - -
Owner Address: t� 9�0 �`/1� �� (�� Zip: S3 SS�
ProjectAddress: -1�s6 W �005� L4�-e p- �����4r�1
Govt.Lot: N�1/4 of NE 1/4,Section�_,T�_N-R b�E❑or W�
Township: R�,v�.� �-4�<-� County: Saw�e�
Project Parcel ID#: b Z`� ��l �`�"y`���
Designer Information
Designer Name: �o� �,a �u�r� Phone: `itS- 6�4- o�3 �
DesignerAddress: l�<<W S� f�w�r �� ff�Hwa�� wrz�p: s�a�
E-mail:
License Number: ZZ�� Z��
Remarks:
Signature: Date: ��"Z�-ZZ
Original signature required ach submitted copy.
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IN-GROUND GRAVITY DISPERSAL AREA SepticTank(s)Manufaclurer:
l,��escr
Stepped Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down-sizing credit)
�000 Seplic Tank(s)Volume(s):
.f�(Z, gal �_ gal gal gal
� W � �� Effluent Ffiter Manufacturer:
� Qa�� La
SOIL COVER
min.12"
(rypicaq Effluent Ftlter Maiel#: SZ�
7 2"
min,irench
TYPICAL TRENCH deplh
CROSS SECTION VIEW �ryPlcal) • �
� _._.. .__ .4., '
"� --•. •• . a <. Provide minimum 3 fi
(No Scale) �..--- sa° ' 4--,T; , � ' separation between trenches.
(�Yplcal) a •
.. . e,. . e.
0
Highest Trench Lowest Trench(as appiicable)
� �
System Elevations= �1Z•S ft, �Z•S ft; ft; ft; ft
Qulck4 Standard-W
w/End Cap Observadon Plpe TYPICAL TRENCH
(Show location of inlet/outlet pipe connection on plan view.) (lyplcal)
(typical) Install per manufacWrer's PLAN VIEW
' InstrucUons. �NO SCa�e�
� -- - - -- - - - - - �� - - - - - - - ��-- - — - - - - -�
� �,' ��- � � � : �� A= 3.0 ft
�� � �'' — — — — — — — — —tl — -- , _—�� (rypical) �
�- - - -- - - - f -- - - - -��- - � �/�— — - - �
B = 7o ft -I m
(typical) Quick4 Standard-W Chamber W
(typical) O
INSTALL PER TRENCH: �mfd ny i�rn�rato�sys�em5,i��.� -n
Install pursuant to manufacturers instructions.
��_ Quick4 Std-W @ 20 fP EISA/chamber= �_4o ft2 �
+ �_ Pairs of end caps @ 6 ftz EISA/pair= � ftZ
= Proposed EISA per trench= 3�� ftZ Required Infiltration Area= b`'�3 ft� Distribution Method: 'I
x � trenches = Proposed Total EISA = bq Z ft2 �►^��—�P a��-���"�
� � PAGE4OF7
GRAVITY-DOSED
SEPTIC / PUMP TANK SPECIFICATIONS
(No Scale)
4"4J Vent Pipe
>10 ft from
Building Electncal must comply with
12"Min.or 2.0 ft above SPS 316 and NEC 300
Established Flood Elevation Extend manhole riser as necessary.
W eathe rproof
(typical) Junction Box
Approved Approved Locking Manhole
IMPORTANT: Vent�ap with Waming LabelAttached
(typicai)
Anchor tank(s)as necessary �—Conduit
pursuant to SPS 383.43(8)(g) a��Min.or 2.0 ft above
Established Flood Elevation
� (typical)
�Airtight Seal
Finished Grade �
_- Quick Disconnect
���)�� 18"Min.
CAPACITIES @ �� �� g e � � ° (�yp��i>
al/in <: °
a. �
Depth (in) Volume (gal)
A Q , * ___ _
V � ,��ti 7 f � Weep �Approved Joints with
3 7 � Hole Approved Pipe 3 ft onto
B 2.� �.�j L q Solid Ground
(typical)
[c] �.'1 � �9��L �
_Alarm
� J� f ' � on -
[c] PUMP OFF
* , + Pump �_off a ELEVATION = -. _. - 1 �:- ft
Pump Tank Liquid Level = in �
° INSIDE BOTTOM
Force Main Diameter = �l in c B�o ke ELEVATION - - �, ft
j �,q ���:2 � ���.-`;n��• .,, d. —
Force Main Length = ��j ft ` 3"Approved Bedding Material Beneath Tank
Ic _
Force Main Void Volume = ' _ gal
[C] Total Dose Volume TDV = (� f 3`1�L' gal/dose rj �;�,5 � _��r
_.— —7 �
(<0.2X design flow+force main void volume) r ��� ( � � �� ��� ,
f
Vertical Lift = ��� 1 ft
PUMP TANK: SEPTIC TANK(S):
Volume = (D�� gal Total Volume = I D8� 9a�
Manufacturer: w�eS�e1� Manufacturer(s): W t 2 5 e�-
Pump Manufacturer: �p,�`f�
Install approved effluent filter at the septic tank outlet
Pump ModeL � (Seea[lachedpumpcurve.) immediately upstr�m of the pump tank inlet.
Controls/Alarm Manufacturer: C Filter Manufacturer: �"d�y �
Controls/Alarm Model: '` � ���At y
Filter Model: �� L
Float switches containina mercury are prohibited.
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PAGE 70F �
In-ground Gravity Management Plan
IMPORTANT:
The owner of this irnground gravity systern shall be responsible for its perpetual operation and maintenance pursuant to
requirements of SPS 38238?, Wisc. Admir,. Code. Pursuant to SPS 383.52 (2),'VVisc. Admir. Code, this system shall
be considered 2 humar, healtn nzzard if not m2intained in accordance with thls aoproved manzgement plan.
Furthermore, all inspection and mair.terance activities sha!I be performed by a registered POWTS Maintainer in �
accord2nce with SPS 383.52 (3),Wisc. Admin. Code.
Maximum Dispersal Area Operetinq Limits:
Design Flow = �S� gpd; BODS<_ 220 mgL"'; TSS 5 150 mgL''; FOG <_ 30 mgL''
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
c a9e cf rys:em
o ruisance factors (i.e. odors, user compiaints, etc.)
c mechanicai malfunction (i.e., pamps. valves. switches, `loats, etc.;
o m2terial tatigue (i.e., leaks, breaks, corrosion; etc.)
o solids volume in anaerobic treatmert tar.k(s) and any distribution appurtenar.ce(s; (i.e., distnbution! drop boxes)
o neglect cr improper use(i.e., exceeding design capacities, prohibited activities, etc.)
c extent of oonding ir distribu:ion cel! priorto dosirg
c dosing irreguiarities- if applicable �r.e.: pump re-cycling, float switch settings, etc.)
o eiectrical componen:s- if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.)
o distributior, lateral or latere! onfce plugging (measure latera! distal pressure—compare to design specification)
o surface discharge o* e`i!uent 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 servici^g operetor licensed under s. 281�8 VVis.
Stats. when the volume of soiids in the tank(s) exceeds one-third (�/3)the liquid volume of the tank(s) or
as required by iocal ordinarce. Disposal o�cortents shall be pursuart te NR '13,Wisc.Admin. Coae.
o Effluent filterfsl shaL' be mspected every 3 years ar,d shall be cleaned when necessary to remove any
accumula:ed solids according to manufacturer's specifications. A servicirg period 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 ccmponent failure or malfunction to:
Name of individua! or compary: RO 6 ��c �G..rC� � � �q Phone: 11 S —bSS — b� � �
Local governmen: uni?: 54_WUtr �o �Oh �n�_ Phone: ��5-63� ��ZBg
Local governrnen? unit address I 0 6 f D Nl ct�r S-� � �-l`'l I-F��w�rd l.e.k�iP: S�-tss�t3
Any detective part of this system shali oe repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc.Admin.
Code. Repair or replacement of`ailed or malfunctioning components shall cemply with SPS 383,Wisc. Admin. Code.
No product for chemical or physicai restoratior or the POWTS m2y be used unless approved by the department in
accordance with SPS 384, Wisc. Admin. Code.
Contin4encv Plan
In the event;hat any:ailed treetment component of ihis POWTS cannot be repaired, it shall be replaced pursuant tc
a plar, submitted tc the appropriate agency for review and approval. A failed in-ground dispersal component may be
abandoned and replaced by a code-complyiog dispersai component in a pre-determired are2 of suitable soils.
Svstem Abandonment
ff ese of tnis POWTS is discor.tinued, it shail be aba�doned in accercance witF. SPS 383.33,Wisc. Admin. Code.