HomeMy WebLinkAbout002-940-19-2205-SAN-2023-152 ��
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1_'.�;;:.z.�.�;:,•-., caunty
r�r�:-._; �'�'t� Industry Services Division sa w ,��n �
i�F hif��:,:.,.�;� 1400 E W2shingfon Ave Sanitary Permit umber(to be tilled in b; Z
__ 5 .� �t� ,� P.O. Bo;�7162
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•,h, ��,r.�, Madison, V�/I 53 70 7-71 62 �s J �'j �
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:—"x fY.a�- J
S tate Transaction Number `��
Sanitary Permit Application ` _
[n accordance with SPS 383.21(2),Wis.Adm.Code,subuussion of this form to the appropriate govemmental unit �/�
is required prior to obtaining a sanitary pennit. Note:Application fonns for s[ate-o�vned PO4VTS are submitted to Project Address(if different than mailing z 9.�
the Deparhnent of Safety and Professional Servies. Personal infonnation you provide may 6e used for secondary
purposes in accordance with the Privacy Law,s.15.04(I)(m),Sta[s. S Q�r
I. A lication Informaiion—Ple�se Print All Information
Property Owner's Name Parcel# `
/Z �� 51�k-rt- �c�,es►� Do2-qYo- I� -���
Property Owner's blailing Address Property Location
i6 $S"� w• Go �b►�et� r o�" Govt.Lot
City,Statz Zip Code Phone Number �W y N�✓ Y<, 3ection '�
Na {�p N� �� ��� cucle one
II.'�'ypeofBuilcling(checicalithatapply) Lot# T_�_N; R_�Eor�N
�lor2FamilyDwelling—NumberofBedrooms �1 � SubdivisionName
Block#
❑Pu6lic/Coilunercial—Describe Use ��
❑ City of
❑State Owned—Describe Use CSM Number �' p Village of
�-? Ot� �I� � To�vn of � G�f� L��
IIi.`3'ype of Perinit: (Check only one 6or on line t�. Complete line'$if applicable)
A.
❑New System �Replacement System ❑Treatment/Holding Tanlc Eteplacement Only ❑ Other Moditication to Existing System(expfain)
B� ❑ Permit Renewal ❑Pennit Revision ❑Chan�e of Plmnber
❑Pennit Transfer to New List Przvious Permit Numberand Date Issued
Before Expiration ' Owner �� _ 3D l.� �� I L'�
1
IV.i' e of P�C3W'�'S.S stem/Com onent/Device: (Check all that a 1 )
��ri P essurized In-Ground ❑ Pressuri.zed[n-Ground ❑ At�Grade ❑ N[ound>24 in.ofsuitable soi] ❑ Mound<24 in.ofsuitabie soil
�,.: - —
❑�K�[e�n�Tank ❑Other Dispeisa]Component(explain) ❑Pretrea�nent Device(explain)
V�Di� ersal/Treatment Area Information:
Desio F[ow(spd) Design Soil Application Rate(gpdsfl Dispersal tlrea Required(s fl Dispersal Area Proposed(st) System Elevation
�Oao -" /,�oo /�oo 00 �3 0 ,�ti �1�. d
V�.'I'ank info Capacity in Total #of Manufacturer y
Galions Galions Units � �, o � �
U �' �- N '+-'
tlz�n-Tx^.'.cs Exisrino Tanks � o Y � � � � �
� c.U cn �., cn u:C7 A- ,
Szptic or Holding i'ank / S—b l � �/�S�✓ -
�-„� v
Dosing Chamher_ . J : '
VTI.Responsibility Statement-I,the undersigned,assume responsibility for instailation of the PObVTS shown on the attached plans.
Plumber's Name(Print) P[umber's Signature 1�IP/N[PRS Number Business Phone Number
i�«�� m �, � -�as-��r� ��s �� �s�
P(umber's Address(Stree,City,State,Zip Code)
�` �
�76o h��� 3s w-�s �-� .�-y
VIII. ou /�e artment Use Onl
�AP � ❑ Disapproved Pennit Fee Date[ssued Issuing Agent Signatur _
� �dC7 � ���t � �3 -� _
`7/�'✓ ❑ Owner Given Reason for Denial �
� . • t:.:ri�
I�.Conditions of Approva]/Reasons for Disapproval �. [`f .� , -'�,.�_.'1���ir._.�! .� ,. ��.
,aa��:� .�,:s����3 � .--�- - - .
_.__., _ : ..� ;:
y, � � �hk# �3 ��� ' �_ -' JUL 1 7 2023 ��--
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' . _.._ -----------
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Attac6 to complzte plans f esystem and submit to the CaunN ool oa pa er not less than 8 v3 s 11 6�tli''sf2r'-'""'"'"`'' ' '
CS ) � 3 ^ � � � NO R��JN�S A�1'ER �/`�!�4�
' ) IS3UE OF RER,'VtlT
��� .,�� .---�-
Hopkins Sand and Gravel ,
27760 State Rd 35 Webster WI 54893
Phone(715)866-4157
Fax(715)866-8104
INDEX SHEET
PROPERTY O�VNER(S)= I� �G�h Sh � �
PROJECT NAME= S�.n'►�'
PROJECT LO CATION= �Co S�J �1 �✓ G o 1 b �a.�1� � �
Street Address
1 q �o�V 9 w
'/4 '/4, Section,Town, Range(for POWTS submittals)
�3�.s s �./�
Municipality
.Sa w y YY
County
CONTENTS PAGE 1: �a i I ��e�0 0�-f'
PAGE 2: `� �,
PAGE 3: ���o f/��� �..
PAGE 4: '� ��
PAGE 5: ��e�I Gra.fs S�C �
PAGE 6: f'i �7F'Y� ,�,�-e�
PAGE 7: /N�G h G f�G w►�[n '�- �I`E h
PAGE 8: � � �
PAGE 9:
PAGE 10:
PAGE 11:
PAGE 12:
PAGE 13:
PAGE 14:
PAGE 15:
NAME: Richard Hopkins SIGNED: /��:/"�`—
DATED: ���J� -" � fi
CREDENTIAL NUMBER: 225851
COMP.MAIV-CTAL USED—Holding Tanks SBD- 10855-P 03/07;R O1/ )
Mound SBD- 10691-P(N.0 1; R. 1 12) �
In-Ground Sys SBD- 10705-P(N.O1/O1; 0/12) `�
Pressure Sys SBD- 10706-P(N.O1/0 , . 1 ��_'. �• I
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innovationsinPrecasl,Drainage �"'` Za��� 1 Z-122 Effluent Filter
&Wasfewa.*er Products � A Division of Potylok Inc.
PL-122 Filter
The PL-122 was the ariginal Polylok filter.It was the first filter on the market with an automatic shut-off ball installed
with every filter. When the filter is removed for regular servicing,the ball will float up and prevent any solids from
leaving the tank. Our patented design cannot be duplicated.
Features: ;
• Offers 122 linear feet of 1/16" filter slots, which : �—� Accepts 1/2"PVC
Extension Handle
significantly extends time between cleaning. � ;
• Has a flow control ball that shuts off the flow of effluent ; � � Alarm switch
when the filter is removed for cleaning. (optional)
• Has its own gas deflector ball which deflects solids away. i � —�-,;=-z
• Installs easil m new tanks,or retrofits in existin s stems. � � 122 Linear Ft.of
y g }' 1/16"Filtration
• Comes complete with its own housing. No gluing of ; slots
tees or pipe,no extra parts to buy.
�
• Has a modular design,allowing far increased filtration , '` '
PL-122 Installation: � ��� �
t
Ideal for residential waste flows up to 3,000 gallons per day i � Filter Housing with
(GPD).Easily installs in any new or existing 4"outlet tee. � 3"&4"Pipe Adapter
1.Locate the outlet of the septic tank.
2. Remove the tank cover and pump tank if necessary. � ���- � � � ��
3. Glue the filter housing to the outle�pipe, or use a � ��_"; � „ .
� �,� 1/16 Filtration Slots
Polylok Extend&Lok if not enough pipe exists. � � �-: �
4. Insert the PL-122 filter into tee. k ��,;� ; 3,000 GPD
5.Replace and secure the septic tank cover. � ���: � �
�;. ,
PL-122 Maintenance: � } �` �
The PL-122 Effluent Filter will operate efficiently for ' � �� ;
several years under normal conditions before requiring = � ° �
cleaning.It is recommended that the filter be cleaned '; ` � ��
every time the tank is pumped,or at least every three years. i
l.Do not use plumbing when filter is removed. k� Gas Deflector
- --- - 2.-Pull PL-122 cartridge out of the tee. auton,ati�shut-off sall
3.Hose off filter over the septic tank.Make sure all solids
fall back into septic tank. ' "
4.Insert filter back into tee/housing.
__, �
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�� � ��� � Potylok offers the only filter on the muket ; ���� � � `� _.='� ��
��_ �vhere you can get more GPD by simply � � �; �
�
� � silapping our filtets toaethex! � � ��
/ � ,t. � j,
�� � Patent[�lumbers � � Outdoor SmartFilterOO Alarm
q/ 6,01�,488&5,871,640 Filter Ready Adapter Polylok,Zabel&Best filters accept
�* Connects to Septic Tank Wall the SmartFilterOO switch and alarm.
www.polylok.com 1-877-765-9�65
lb,i�'�1'dA.�G�l'V�T�T`d�'���I`�T�'�G�'�Z A i��'`�'�C'�'�IVK Al'�T� S��A����1''�'��I'1 COI'v�'�IV��1'1T
. _ �
Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access
openings used for service and assessment sha�l be sealed tivatertight upon the completion of service. Any
opervng deemed unsound, defective, or subject to faihire must be rep��ced. Exposed access operungs
�� greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or
tmauthorized entry into the tank.
1Vo o�e s3�oulcl e�ter a septic or ot�er treat�en# or h�ldi�g tauk for any reasan
witho�t be�ng in f�11 cou��l�a�ce with ��S�A sta�darcls for ente�iug a conf'�ec�
spa��e. The a�iiosp�e�e ti�vi#hi� tha s�p�ic or other treat�ien� or holdi�g ta�may
contai� let�al g�.se�, �a�d �escua o� � pe�so� f�-o�a the in#er�or of the �a�� m1y be
cl�fic�l�or impassib�e.
Tank abandonment shall be in accardance with SPS 383.33, WI § when the tank is no longer used as a
POWTS component.
.
S��A�S��'�'��I�T C�1'��'�IV�l�T�'
The soil absorption component sei-ving this stn.tcture is designed to accept domestic wastewater from a
residential facility. The limits of operation of this component are shown in Table 2.
Tlie longevity.of a soil absorption component depends greatly on proper and timely maintenance, and
system use within or below the limits of reliable operation. Good water conservation practices by all
occupants and fihe installation of water conserving plumbing �tures are key factors in extending the
useful life of this component. '
� The soil absorption component's operafion must be assessed by i.nspection at least once every 3 years.
This inspection shall include recorcling the levels of ponding, if a�zy, in tb.e observation pipes, and a visual
inspection for any evidence of surface seepage or discharge from the component. On steeply sloping
sites, areas of erosion should be identifieci and reported to the owner for repair: The surface discharge or
clomestic wastewater or s ewage from the system is prohibited and considered a human health hazard.
Traffc around or over the soil absorption component should be avoided particularly during winter
months. The compaction or removal of snow cover over the component may Iead to hydraulic failure by
freezing. T�s type of failure is usually temparary, but is difficult or impossible to repair until weather
conditions improve. In general, soil compaction over this component wiIl reduce diffusion of oxygen into
the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil.
Plantings of deep-rooted trees and shrubs clirectly over ar withi.n ten feet of the component should be �
avoided since root intrusion into the component may obstruct wastewater flow.
��pn� �'aa�k
The pump (dosing) tank shall be inspected at least once every 3 years. A11 switches, alarms, and pumps
shall be tested to verify proper operation. If the effluent filter is installed within the tank it sha11 be
inspected and serviced as necessary. "
,
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P1�IVr�TE ONSI�'E WASTEWATEI2 T�ATIVIENZ' SYS�'EIVI MANAGEMENT PLAN
SEPTIC TANK AND G1�AVITY IN-G12O�JND SOII. ASS�RPTION COMPONENT
Pursuant to SPS 383.54 WI §, each Private Onsite Wastewater Treatment System(POWTS) shall include
information and procedures for maintaining the system within the parameters of SPS 383 and 384, and the
conditions of approval by the department, agent, or governmental unit. The approved plans and pernuts
for the system are on file at the county zoning office.
This management plan complies with SPS 383.54 WI § and the In-Ground Soil Absorption Component
Manual for Private Onsite Wastewater Treatment System SBD-10705-P (N. O1/Ol: R. �10/12).
Table 1: S stern Desi n S ecifications
Sanitary Permit Number
Number of Bedrooms
Des:gn Flou•—Peak(gpd) !o b�
Estimated Flow—Average(gpd) �l d U
Septic Tank Capacity(gal) IJ.SO
Soil Absorption Component Size(ft-) /�.a�
Type of Wastewater
Table 2: Soil Absor tion Corn onent—Limits of Reliable O eration
Septic Tank Com onent Soil Absorption Component
Design Flow—Peak(gpd)
Maximum Influent Particle Size (in) N/A 1/8
Maximum BODS(mg/L) N/A 220
Maximum TSS (mg/L) N/A 150
Maximum FOG ' N/A 30
Table 3: Maintenance Schedule
Se tic Tanlc Inspect and service once every 3 years
Outlet Filter Should ins ect once a year and clean once every year
Soil Abso tion Component ' Inspect once every 3 years
SEPTIC TANK
An individual certified to service septic tanks t�nder s. 281.48, Stats, shall maintain the septic tank. •The
contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing
--- Septic or Holding Tanks; Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits,Seepage
Trenches,Privies or Portable Restrooms).
The operating condition of the septic tank and otrtlet filter shall be assessed at least once every 3 years by
inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge
should not be removed unless provisions are made to retain solids in the tank that may slough off the filter
when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the
alarm is activated continuously. Intermittent filter alarms may indicate surge flows ar an impending
continuous alarm. The septic tank shall have is contents removed when the volume of scum and sludge in
the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time
of an assessment, maintenance personnel shall advise the owner of when the next service needs to be
performed to maintain less than maximum scum and sludge accumulation in the tank.
'��;"'"T"�"�:; pRIVATE ONSITE WASTE TREATMENT co�nty
=��a$ SYSTEMS
'>�.� Ps ,� ( POWTS) SaWyer
\�. �—�%
` ""�' INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �� ` �S�
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Viilage Town of: State Plan Transaction ID#:
'1� a�t d'��'`e.s'"� S"1�-►� �a f �� �
Insp BM Elev: BM Description: Parcel Tax No:
t��a` N-c�,l i� L'�"�ti�C �oa _�Yo_(�'_�2as—
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �Q,�T 1 � Benchmark (op,p�
Dosing
Aeration Bldg. Sewer �S( '"
Holding St/Ht Inlet QY, '
TANK SETBACK INFORMATION St l Ht Outlet 9Y.a1`
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic �, ` -F�� a.Y .�.,2 NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. �7,pc�'
Holding B+sF+�e- ( c�3,3�.�
PUMP 1 SIPHON INFORMATION � � q 3,l2 '
Manufacturer Demand F�a�6�de 3 Q�.61 �
Model Number GPM Y `l�-�f
TDH Lift Friction Loss Sys Head TDH Ft � �,9��
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFORMATIO
DIMENSIONS W � 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 � EZFIow Model Number:
CELL TO �� � 0 N ❑ Mound o Other
— ___ �_ -�—
___ -- ---- _. __--- ___ — --_--
DISTRIBUTION SYSTEM X Pressure Systems Only
--- ----------T
Header/Manifold Distribution Pi e s X Hole Size II X Hole Observation Pipes
Length Dia Length Dia Spac ' � Spacing ❑ Yes ❑ No�
P � )
SOIL COVER
---- ------- - ------ -- —
Depth Over Depth Over ' Depth of Seeded/Sodded Mulched
Cell Center � Cell Edges Topsoil � 0 Yes ❑ No � ❑Yes ❑ N�
-____
COMMENTS: (Include code discrepancies, persons present,etc.)
�l�,s�j!� 8(3 o j a 3
Plan revision required?❑ Yes ❑ No i�3' �� �__J��vv ------� ��� �
� ( l L
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AOOITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER __ ___0�-�1�So�_ _
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