HomeMy WebLinkAbout008-937-08-5218-SAN-2023-195 -- �•"" Industry Services Division Connry
,`.,,_ _�`'-. l/J
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=" 4822 Madison Yards Way ��.u� / �
�x� :,�_ = Madison,WI 5370� Sanitary Pemiit Number(to be fiiled in by
t ' :
� _ ,;j P.O.Box 7302
.@� Maciison,WI 5302 (p ,� ( � �� ��
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Sanitary Permit Application State Transaction Number ,
In accordance with SPS 383.21(2),Wis.Adm.Gode,submission ofthis form to tUe appropriat�govemmental unit � �
is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS aze submitted to Project Address(ifdifferent than mailing a (/�
the Deparlment of Safety and Professional Services.Personai i�ormation you pmvide may be used for secondary � 1 n � �
ses in acwrdance with the Priva Law,s. 15.04 1 m,Stats. J/_[/�� (� ��/ e ��
L A tication Information—Please Print All Information ��v �
Pro erty Owner s Name Parcel#
�;►l; �c>«�c�i'G(i5 ��S3�U�' sal:�
Property zr's Mailing Address Property Location
s�S ��iS �o r�t.�,'zi� b Z L C) i'�T a-3
Govt.Lot
City,State Zip Code Phane Number 'I _
�C:iWI�EG�f p�!lJ 5✓�G3/ �"L '/,, '� �'� '/., Section � �
II.Type of Building(check all that apply). LOt� T �3 7 R d� E or
� 1 or 2 Family Dwelling-Number of Bedrooms � � Subdivision Name
❑Public/Commercial-Describe Use Block#
— ❑City of
❑State Owned-Ikscribe Use
CSM Number ❑Village of
�Town of � ��yZ'�
3��2-78 �.�7S
III.Type of POWTS Permit: (Check eit6er"New"or"Replacement"snd ot6er applicable on 6ne A. Check one bos on line B.Complete(ine C if
a licable.
'�' �New Syatem ❑ Replacement System ❑Chha Modificaiion to E�asting System(explain) ❑ Additional Pretreatment tlnit(explain)
B' ❑ Hoiding Tank � In-Ground ❑ At-Grade ❑ Mound �] Individual Site Design yp ( xp )
❑ Qther T e e lain
(conventionai)
C• ❑ Renewal Before ❑ Change of Plumber ❑ Transfer to New �Ft Previous Permit Number and Date Issued
❑Revisian
Expiration Owner �-
IV.Dis ersaUTreatment Area and Tank Information:
Design Flow 4gpd) Design Soil Application Raie(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(sfl System Elevation
l5� , 7 ���� ��c� �q2.� �
Capacity in Total #of Manufacturer �, h �
Tank Information Gallons Gallans Units � V � � � �
New Tanks Existing Tanks � e� � P..
m � � �
� `i' w
0
Septic or Holding Tank / ysp� s(�U � 1/( (,rl��/ x
Dosing Chamber
V.Res nsibili StBtemeIIt- I,the imder.rlgned,assame tYaponsib�ity for inst911ation of the POWTS slrown on the attached plaa4.
Pl er's Name(Print) ber's Signature MP/MPRS Number Business Phone Number
�� i��Q.Jrc)�s �` � �y.�>:�5- '7iS-��-�3i33
Plumber's Address(Street,City,State,Z� Code) r-
���U ayc ��� ��� t� �f s�ia���
VL C u t /De artment Use Oni
� �� ❑Disapproved Permit Fee Date Issued Issuing Agent Signature
❑Owner Given Reason for Denial $ f��•� ������� -y ���-fA�/u-3-
Conditions of Approval/Reasons for Disapproval '�'t�— �
. ,r-.� ,
�
� , I � -U��^�.�1 ry(^�J� i ---i .�
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, � .�ra�_,,.,...,..�3�.I.a�vl-�.._. ..-.,:.._..,,s,_*._.-,_-_ *i1� �L�f�J L�"� ` L-...� i
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i'r ���' ���a ....� x
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a�G 1 � 2oz�
�T � 3- i a 5 �'�����_a���.�__r.�..w��... �.�....
�pWYER COUNTY
��C,.qpPAIN1�TF�ATION'
Attach to complete plans for the system and submit to the County only on paper not less than B 1/2 z 11 inches fn size
'1 ���'I S
SBD-6398(R 02�22) NC���JIvDE qFTER
15SUE OF PEFifl�l�'
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 Piot Plan
Pg 3 of 4 Dispersal Area Cross-Section & Plan View
Pg 4 of 4 Management Plan
Attachments: Enclosures:
POWTS Application for Review
Soil Eva{uation Report & Site Map
Project Name / Description
Owner Name(s): �;!l�0 �c�C��lc�i G�i S Phone: - -
Owner Address: a5 a�/F ,�G����� 6'�-�) -���^ �"�c► Zip: 5����/
Project Address: l!� y��� /���%w��.) Lv� �i��w�,;�� ,�r S4�1�
Govt. Lot: �-3 �J C 1/4 of :� � 1/4, Section �� , T J � N-R d� E❑or W �
Township: t�Q�,...rc� County: S���af
Project Parcel ID #: C���3�d��`�1',�
Designer Information
Designer Name. ���> Phone: �/� - 2c5 - s',�/3�
Designer Address: a�l��l�4� ��� '�c.�L�� �'� ��1��� Zip: .Sl/l���
E-maiL• � � � �
License Number: a�ra �a.�
Remarks:
� �- �-z�
Signature: � Date:
Original signature required on each submitted copy.
CHECK 00%A�APRIC�BLE- CHEC1(60X AS AP?LICA3�E
� SOIL EVALUATION sca�e:�"=ao' �SYSTEM PAGE 2 OF
SITE MAP � 40 � � pLOT PLAN
PROJECT NAME <J
� �Q� OESIGNfLOW. // :�PD
j/��� � !,'U(.�hq�(/�5 I Anach design flow calculations tor wmmerclal plans.
PROJEG7ADDREsS�. ���� Z w ��vu�4 ee.�(„� //�� Pipe Material/ASTM Standard(TaWes 384.30-3 8 384.30.5)
—iF-AI"-�L— sannarr sewec Ci"Sd vu pU��c�"'u�.y �'k_,c
BM Symbol-.+ BM Elevalion'. �� FT �`��� _ -
I Fcrce Man'. /
BM DascnPllon�. 'i i l��^�L1..
Siope Gradiem�;) '-� makai-�onr ni IMPORTANT:
orTesteanrea�. /�` / '�'eilsyrribul(itappi�rablel. Q o�aw�naa,a�o« ShowgrnuncialevatlmcontnursalsuilaMeinterval.s.
an t�e aypropr'de Ire.
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IN-GROUND GRAVITY DISPERSAL AREA �°"`Ta"k'S>""a�°'�`°`e'.
�N����,�J�
Stepped Elevation Trenches with Quick4 Standard-W Chambers
Septic Tank(s)Volume(s)�
3-ft Trench (down-sizing credit) ,�_\
`�W gal gal gal gal
� J �/(J� EHluent Filter ManufacNrer
SOIL COVER " ��
min 12' �� - ��S
�rypmap ERluent Filter Motlel#:
iz
TYPICAL TRENCH �'dePe��h
CROSS SECTION VIEW 1NP"a0 •
' a . Provide minimum 3 fl
(NO SC818) � aA� �`-� ., �� � separation between trenches.
OVPiwp � . � .
, . • :
Highes Trench Lowest Trench (as applicable)
System Elevations= __F� ft: ft; ft; ft; ft
Quick4 Standard-W
w!End Cap Observatbn Pipe TYPICAL TRENCH
(typical) (Show location of inlet/ outlet pipe connection on plan view.) Iav��9
InstallpermanulacNreYs PLAN VIEW
ins�ructions. �(�f0 SCB�@�
r __. — _ - - - _ _ _ — JL _ - - _ _ — �/ - - _ — _ - - - �—
�IRt�t�f�►ttf11����1" // /� •11RR• tf��t11 •f�ll#RNi�
+t �I o . n � A= 3.oR
Lu��y��aauair111Y11�1 _ ia�ri�a�f1��1�iY��l 1�YPical) �
- - - -�f- - - - - - - - -�� - - - - - - - - - D
F B = � ft � I m
(typical) Quick4 Standard-W Chamber W
INSTALL PER TRENCH: �ryP���� �
(mfd by Infilirator Systems,Ina) —n
� Install pursuanl to manufacNrefs instmctbns.
�� Quick4 Std-W @ 20 fC EISA/chamber= z � ft` �
+ � Pairs of end caps @ 6 ft'EISA/pair= � ft'
= Proposed EISA per trench= ��L ft� Required Infiltration Area = '? �y tt� Distribution Method:
x � trenches = Proposed Total EISA = ��' ft= � �G�,�j
�
PAGE40F4
In-ground Gravity Management Plan
IMPORTANT:
The owner of this in�round graviry 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 mainlained in accordance with this approved management pfan.
Furthermore, all inspection and mainlenance aclivities shall be pertormed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3), Wisc. Admin. Code.
Maximum Dispersal Area Operatinq Limits:
Design Flow= /J� gpd; BODS <_ 220 mgL-'; TSS _< 150 mgL-'; FOG 5 30 mgL-'
Insnection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors(i.e. odors, user complaints, etc.)
o mechanical maffunction (i.e., pumps, valves, switches,floats, etc.)
o material fatigue (i.e., leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treahnent ta�k(s) and any distribution appurtenance(s)(i.e., distribution/drop boxes)
o neglect or improper use (i.e., ezceeding design capacities, prohibited activities, etc.)
o extent of ponding in distribution cell prior to dosing
o dosing irregularities-it 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 onfice plugging (measure lateral distal pressure—compare to design specification)
o surface discharge of effluent or sewage back-up into s[ructure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Septic and dose tanklsl shall be pumped by a certified septage servicing operator licensed under s. 281.48 W is.
Stats.when the volume of solids in ttie tank(s)exceeds one-third (113)the liquid volume of the tank(s) or
as required by local ordinance. Disposai 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 manufadurer'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: {(� rJ,„ ��b'cl,a Phone: 7/5- .�34� ���
Lxal govemment unit �w: /'c•,x.�F� Zo"t,tjH t_ Phone: 7�5 " �2�' �Z��
Local govemment unit address: IUCP/D l�xc'N 5� #� ZIP: � �y3
Any defective parl of this syslem shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc.Admin.
Code. Repair or replacement of failed or malfunctioning 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 lhat 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 approval. A failed in-ground dispersal component may be
abandoned and replaced by a code-compiying dispersal component in a pre-determined area of suitable soils.
Svstem Abandonment
Ii use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
��INFILTRATOR9 IM-�J4O
�
�
tanks
Features & Benefits
• Strong injection molded
� ` "� ol ro lene construction
P YP PY
• Lightweight plastic construction
* �,,, and inboard lifting lugs allow for
��
easy delivery and handling
• Integral heavy-duty green lids that
;;�.. interconnect wRh TW'" risers and
+, pipe riser solutions
• Structurally reinforced access
ports eliminate distoRion during
installation and pump-outs
• Reinforced structural ribbing
offers additional strength
• Can be installed with 6" to
48" of cover
• Can be pumped dry during
pump-outs
• SuRable for use as a pump tank
or rainwater(non-potable)tank
The Infiltrator IM-540 is a lightweight strong and durable septic/pump tank. ' No special installation, backfill
This watertight tank design is offered with Infiltrator's line of custom-fit or water filling procedures
risers and heavy-duty lids. Infiltrator injection molded tanks provide a are required
revolutionary improvement in plastic tank design, offering long-term ' No special water filling
exceptional strength and watertightness. requirements are necessary
• The tank may be backfiiled with
suitable native soil. See installation
instructions for guidance.
.F_ ` Reinfaced 24" ' � Custom fit
�"�'• structural -� "' TW Riser
access port
_ � \
�� �
', \�� Reinfaced
watertight �
mid-seam .
gasketed �
.
connection
l
� � 1
, � ��
��.
Protecting the Environment with Innovative Wastewater Treatment Solutions � N F I LT R ATO R°
water technologies
IM-540 General Specifications and Illustrations
A A'
The IM-540 is an injection molded two piece mid-seam o ,
plastic tank. The IM-540 injection molded plastic design _
61]
allows for a mid-searn joint that has precise dimensions o . E�1ER�bR
for accepting an engineered EPDM gasket. InfiRrator's , '"'oT"
gasket design utilizes technology from the water industry
to deliver proven means of maintaining a watertight seal.
The two-piece design is permanently fastened using a
series of non-corrosive plastic alignment dowels and �9i�,soeiezreR�oR�E�,�1 „m„�„r�
locking seam clips. The IM-540 is assembled and sold C��qpi TOP VIEW "�1Pj
through a network of cert'rfied Infiltrator distributors. �`"'
Mll£TCOHNECTpN
Must be backfilled and installed in accordance with �^'o�
Infiltrator Water Technologies, Infiltrator IM-Series Septic �
Tank General Installation Instructions and for shallow
ground water conditions reference the Infiltrator IM-
Series Tank Buoyancy Control Guidance. so s
[1,38]�
Please visit www.infiltratorwater.com�mages/pdf/ �c°R
ManualsGuides/TANK01.pdf for the latest infortnation. �
�
END VIEW
Total Capacity 552 gal(2090 L)
LEf1 Jth 64.9"(1648 mf11) :a�e�a�a.m.nccEss oawwc wiTM�ocKMc uu
Width 61.7"(1567 mm)
iN�Fr
HeigM 54.6"{1387 mm)
Mauimum 8urial Depth 48"(1219 mm)
Minimum Burial Depth 6"(152 mm)
Manimum Pipe Diarneter 4"(100 mm)
Weight 1691bs Q7 kg)
SECTION A-A'
CONnMIWS
GASIQf
TNlKTOP
ry�� SFAMQIV
TANK
INTERIOR
MIC�lYAEM
DpNFL
TRHI(BOiTOM
� HALF
d susiness Park Roae MID-HEIGHT SEAM
P.O.eox�6B SECTION DETAIL
OW Saybmok,CT O84I5
INFILTRATOR¢ ��-��5"'�'
. www.IniiltMorwaler.com
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EQuel¢er,Oukk4,ard SWeWiMer are re7is[aetl baCemarks oi Infikrator Water Tech�wbgis.Infilhator is a repL5leletl Natlemerk In Fra�e InfiA�ator Wa[r Tec�robgi�k a regrsteratl tratlamark In Meieko
Coritour,M�croLs�c�inp.PoyTUH.ChambdSpxer.MuttiPorl,PosiLock,Ou'ickCul OulckPlay,SnapLocN antl Stralqhtl.ock are�stlemaAo o(InfiArator W��c Txcnnolopres.
PotyLok ia a Uatlaman of PoryLoM,Ina TUG�TRE le a repKrorstl vaE«nark ol Tl1F�TITE,WC.Ulim-Rib la a tmtlemaM1 ol IPEX Inc.
r020131n(Ittrs�or Wate�Txhrrolagles,LLC.All rlgMs rmervetl.Pdntetl In LL9A. ItA11 1116
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Soil Profile Sheet
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srsaem Elevadon: , S� Loed Rat� .: � sysoem Rangr. 9/ to��
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