HomeMy WebLinkAbout002-184-13-0400-SAN-2023-176 Industry Services Division County � �
� 4822 Madison Yards Way �`"U � �
; �_ - Madison,WI 53705 Sanitary Permit umber(to be filled in by Cc
'= P.O.Box 7302 �
Madison,WI 5302 SO�y P/� W
Sanitary Permit Application State Transaction Number �
In accordance with SPS 38321(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-0wned POWTS are submitted to Project Address(if different than mailing ad�
the Departrnent of Safety and Professional Services.Personal information you provide may be used for secondary �" _r� �
purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. ����� '�C �'��rl�`�
l.Application Information-Please Print All Information S'�t7Wri�.11�G
Propert}OH ner s Name Parcel# �O�,. ( - - d 0 0
g���;- �, �, � C�,��( � ������, � r - -
Property Owners Mailing Address Property Location
��,� �����y(���P� Govt.Lot
City,State Zip Code Phone Number /
W ��C�!. '\ J`�' � � s. �� ��a, ��a, SCCYIOII�
J S�(" �I
IL Type of Building(check all that apply) � Lot# � T �� N R� � E o W
�-1 or 2 Family Uwelling-Number ofBedrooms Subdivision Name
Block# ��1`°jyL AT (t'sL'�� L
❑Public/Commercial-Describe Use 1 � —
� ❑City of
❑State Owned-Describe Use CSM Number ❑Village of _
GrI'own of��t:f 5 L c I.-�.
I11.Type of POWTS Permit:(Check either"New"or"ReplacemenY'and other applicable on line A. Check one box on line B.Complete line C i
a licable.
A ❑Other Modification to Existin S stem ex lain ❑ Additional Pretreatment Unit(ex lain)
L7New Sys[em �Replacement System S,Y ( P ) p
B' ❑ Holding Tank �In-Uround ❑ At-(irade ❑ Mound ❑ Individual Site Design ❑Other Type(explain)
(conventional)
C. ❑ Renewal Hefore ❑ Revision ❑Change of Plumber ❑Transfer to New Owner List Previous Permi[Number and Date Issued
Expiration uh K �
l
IV.Dispersal/Treatment Area and Tank Information:
Design FIoH�(gpd) Design Soil Applicaiion Rate(gpd/sfl Dispersal Arca Required(s� Dispers�l Area Proposed(s� System Elevation
�-1 � o � '—� �a c� � ,5� �a — 9 �
Capacity in Total #of Manufacturer y c
Tank Information Gallons Gallons Units ,� � o � �
New Tanks Existing Tanks � � � � Y ,n � �
a U �n � v� w C7 0.
Septic or Holding Tank O O� 1,�� { �{ C���
/
Dosing Chambcr
V.Responsibility Statement- I,the undersigned,assume r po ibility r in Ilation of the POW'TS shown on the attached plans.
Plumber's Name(Print) Dan Burch Plumber's Si na re MP/MPRS Number Business Phone Number
253808 715.4I6.1642
Plumber's Address(Street,City,State,Zip Code) N5921 County Hwy K Spooner WI 801
VI.C u ty/Department Use Only
�Ap e ❑Disapproved Permit Fee Da[e lssued Issuing Agent Signature
❑Owner Given Reason for Denial $ y�•� �'�I I J-� �`'�'�'C���e�/�"��
Conditions of A�rovai/Reasons for Disa roval r��''^� '' ' � ;
Pp Pp � �';I ` ' f`}t
� '�-�i �'�;:_;';� �, ; ,�
�_�.� '-�=-%—} � +I
, E
�""'� A A , . . . f
' 1
t� ,
�y t
, ,, d�oo __ AUG 0 3 2023 �--�
�r rt '�,,.-�� �::hk#_ m. .,. - --- -
� C ,.> .,�;'�;_ ��$��. .. _ gA.\�iYF_'� CO�.��J 3�
J��� — zor11NU'.AD�vt!N!��rATiQN
Attach to complete plans for the system and submit to the County only on paper not less than S v2 x 11 inches in size �
�S�
SBD-6398(R.02/22) NO REFUNDS AF7ER
I:;SUE UF P'ER�/lll'
+�N
PAGE 1 OF 4
In-Ground Gravity Plan
Index & Cover Sheet -
Component Manual Design References:
In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
Pg 1 of 4 Index & Cover Sheet
Pg 2 of 4 Plot Plan
Pg 3 of 4 Dispersal Area Cross-Section & Plan View
Pg 4 of 4 Management Plan
Attachments: Enclosures:
POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description
Owner Name(s�: �t�� `� `g'�0L ��- � E s��n`�'�✓�2S Phone: - -
Owner Address: �'�� ��Nh`�4Cl�E2 yy<��s,�✓ l2aP�OS Z�p; ,�`�y Y�l
Project Address: �� �� � u v � r1�i4 2� � �
fi�v�Lot: � 1/4 of 1/4, Section , T 3� N-R � E Q or W �
Township: ��SS �q/r� County:
Project Parcel ID #: ��� 1 $`� � 3 t7 �( � �
Designer Information
Designer Name: Dan Burch Phone: 715 _416 _1642
Designer Address: N5921 Cty Hwy K Spooner WI Z�p: 54801
E-Rlal�: bUl'Cr1p�U111b11�1g111C C�l gll'lc'�I�.COfTI i�h�>�F��;�v.i��er�;�,d �orr apprc�3a�;tan»,
License Number: 253808
Remarks:
Signature: Date: � �� � �
Original signature required on each submitted copy.
CHECK BOX AS APPLICABLE. CNECK BOX AS APPLICABLE.
�SOIL EVALUATION 0 Scale: �30 30 a5 so l.ITSYSTEM PAGE 2 OF
SITE MAP PLOT PLAN �
PROJECT NAME: 7 SZ DESIGN FLOW: _` �� GPD
,t,,L��.y�J, �U�"� Attach design flow calculations for commercial plans.
PRo.fECT ADDftESs: �v b �, ✓V l;f�'���k�4'j, Pipe Material!ASTM Standard(Tables 384.30-3&384.30-5)
N Sanitary Sewec S�.� �J��`+�
BM Symboi: -� BM Elevation: � FT � Fa�Main: !
BM Description:
slo eGradient %) � Indicatenorthby IMPORTANT:
P ( � Well Symbol('rf applicable): 0 drawing an arrow Show ground elevation contours at suitable intervals.
of Tested FUea: on the approprite Iine.
� � O / ��` �� �� 1 '
�J `� � � / � �
� /
ti� ��4 � ��� ,�
� � � �
� �. � , ��5
��� � � \o� n` '` �
� � � ��,� , �� \
� � l
� ��� � ���� r
� o��
� � ,GS°`I �
/ V � 1
� / ,`�i.. �� �� /
lt�"� � s s `�
J
v� �J ��
�� b�i �
��v �,
c, k , ��
� �,� �,.d'
� �\ �-�
�
� ���� � �
� 3� � �
��
�
� � ��
�
�
. �� �
�(��� �, , �a� L,
` �� � U
� � � `
� � a� �
IN-GROUND . � �GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down-sizing credit}
�
min.12�� TYPICAL TRENCH
SOIL COVER (�pi�l�
CROSS SECTION VIEW
,z•
min.trench (No Scale)
depth •
��YPIC21) •'. a '
, , .e'� '
, �• ' . .d 'e
r �o '�• < .. .
(typical) ':'a ^ :� e.. . ;' � Provide minimum 3 ft
. • ° ��_g� separation between trenches.
System Elevation = ft
(typical)
Quick4 Standard-W
w/End Cap Observation Plpe
(typicaq (Show location of inlet/outlet pipe connection on plan view.) �typ���> TYPICAL TRENCH
Install per manufacturer's
mstructions. P�N v�EW
� - -_- - ,- - - - - - ��-- - - - - - - - ��- - - - � —..a -.�,—, ,.. — � (NoScale)
`�� �A= 3Aft
��r
, a�F, �,zi�;���b � ° �
�- - - - - - - - - - - - - - - - - - - - - - - —Po ��ra'� �,"��iF_ � (�Pical)
�� ` �'� -0
_i
g = � ft �
(rypical) Quick4 Standard-W Chamber ('i�
INSTALL PER TRENCH: �tyP���� W
(mfd by Infiltrator Systems,Inc.) O
Install pursuant to manufacturers instructions.
Quick4 Std-W @ 20 fi� EISA/chamber= 3�� ft2 TI
+ Pairs of end caps @ 6 ftZ EISA/pair= � ft2 �
= Proposed EISA per trench= 3 � � ft2 Required Infiltration Area= �vl� ftZ Distributio Method:
� _ - -d5 � 2 �� �Cr
x trcnchcs �roposed Total EISA - ft
PAGE40F4
In-ground Gravity Management Plan
IMPORTANT:
The owner of this in-ground 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 heaith 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 Disqersal Area Oaeratina Limits:
Design Flow= ���� 9Pd� BODS<_220 mgL"'; TSS 5150 mgL''; FOG 5 30 mgL''
Insaection Checkflst 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.) i e.,distribution/drop boxes)
o solids volume in anaerobic treaVnent tank(s)and any distribution appurtenance(s)('.
o neglect or improper use(i.e.,exceeding design capacities,prohibited activities,etc.)
o extent of ponding i�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 tankfsl 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(1/3)the Iiquld volume of the tank(s)or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113,Wisc.Admin.Code.
o Effiuent fllter(sl shall be inspected every 3 years and shall be deaned when necessary to remove any
accumulated solids according to manufacturer's specifications. A serviang period will always be greater than 12
months.
System malntenance reports shali be submitted to the proper local government unit in accordance with
SPS 383.55 Wlsc.Admin.Code. Report any component failure or malfunction to:
Name of individual or company:
Dan Burch Phone: 715.416.1642
Sa er Count Zonin Phone: 715.634.8288
Local government unit: � y 9
Local govemment unit address:
10610 Main St. #49 ZiP: 54843 _
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 maifunctioni�g 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.
Continaencv Ptan
In the event that any failed treatment component of this POWTS cannot be repaifed,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-complying dispersai component in a pre-determined area of suiiable soils.
Svstem Abandonment
If use of this POWTS is discontinued,it shall be abandoned in accordance with SPS 383.33,Wisc.Admin.Code.
WLP1 �00— MR
TANK SPECIFICATIONS � o
a'-a" � a
DIMENSIONS: � ~
� o
WALL: 2 1/2" � �
4" CAST-A-SEAL 4" CAST-A-SEAL BOTfOM: 3"
COVER: 5"
��;=______"���
MANHOLE: 24" I.D. PRECAST CONCRETE RISER Q
�� ��
HEIGHT: 53 1/4" �
��%� ���� LENGTH: 8'-8" �
ii �� WIDTH: 7'-2" �
ii� �_, `L�` �� BELOW INLET: 42"
@ Q T�
� ' ` '�y � `� � LIQUID LEVEL: 36" �
`� i � WEIGHT: 6,790 LBS. -� a o �
0
� ��� �__�� �� _� ��� INLET AND OUTLET: _� � o 0
�� // 4" CAST-A-SEAL 800T OR EQUAL GASKET � m o a
�� FILTER OR // o
��� BAFFLE �i� � 3 [,; 3
�� ,� INLET AND OUILET BAFFLE AND FILTER: Q Q � ,;;
`�.�_ ___ ,�:' WISCONSIN, SEE DETAIL #10 � o o �
` ------��� (OTHER STATES SEE CHART) �, o
�
�
UQUID CAPACITY: 27.83 GAL/IN W �
jOP VIEW � �
HOLDING TANK:
OUTLET HOLE PLUGGED � � �
ACTUAL CAPACITY: 1,085 GALLONS 0 � �
V o I
LOADING DESIGN: 8'-0' UNSATURATED SOIL Q �n
� N
� TANK CAN BE USED AS: � o �
Q � SEP11C / HOLDING / PUMP OR SIPHON W 3 0
� COVER: MIX DESIGN �8 (NO FIBER) � �n �
�
� TANK: MIX DESIGN #10 (STRUCTURAL FIBER) � �
---- ---- �_ CUSTOMIZED TANKS: � 3
---- ` ' ' � ---- FOR CUSTOM TANKS CONTACT WIESER CONCRETE
WLET - OUTLET
M �U { - � - - - I -
N
Q
� � a I - �n I �� _ J
d � � j M � j � : � � �
� � Z
2�„ E-----�----------G=^ =� � a
o �
REVIEWED BY � U
;.,� PUMP PAD REVIEW DATE � d
w
DRAWINGS SUBMITTED �
si�E wEw FOR APPROVAL
APPROVED BY: SHEET N0.
APPROVAL DATE: •� �
OF
PRODUCTS NEEDED BY: / �
TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS