HomeMy WebLinkAbout008-118-15-0001-SAN-2023-257 .,o�""'"'F�r, Industry Services Division County (n
'�+ v; 4822 Madison Yards Way ��� �
� ��s! ` K Madison,WI 53705 Sanitary Permit umber(to be filied in by C �
,��, �, P.O.Box 7302 r
��, M a d i s o n,W I 5 3 0 2 �, � j `,��� � w
Sanitary Permit Application S�e Transaction Number 1
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the�propriate govemrtental unit �
is required prior to obtaining a sanitary permit.Note:Applicarion fottns for state-owned POWTS ace submitted to Project Address(if different than mailing ad �J
the Deparkment of Safety and Professional Services.Personal information you provide may be used for secondary /L t� �1 ���L ��
purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. � ) �"
L Application Information—Piease Print Al1 Information �''�L�u_xx�� w� c���7
Properry Owner's Name Parcel#
I 1�w 4J � �i� �y5���1 c�c�� - i 1� -►5= oo�!
Property er's Mailing Address Property Location
� tv �d 7`� �w•� 1� �/ GovC Lot a
Ci,ty,State Zip Code Phone Nutnber ..
G`?U N�-i L.G II v G�') � �S�U �� '/•, `5� %., Section ��
IL Type of Bailding(check all t6at applp) Lot# T 3� N R E o W'
�i or 2 Family Dwelling—Number of Bedrooms � Subdivision Name
B��k# ��lt 6�' 6' e�r
O Public/Commercial—Describe Use �.
❑City of _
❑State Qwned—Descn'be Use CSM Number V_i Village of /",�o � _
.—_-- �1 Town of CJ X`"Y"�� _
IIL Type of PUWTS Permit:(Check either�New"or"Replacement"and other appIicabie on[ine A. Check one box on tine B.Complete line C'
a licable.
A.
(,� New System � Replacement Sysiem ❑ Other Modification to Existing System(explain) ❑Additional Pretreatmeni llnit(explain)
B' ❑ Holding Tank �In-Ground ❑At-Grade ❑ Mound ❑ Individual Site Design ❑ Other Type(e�lain)
(conventionai)
ist Previous Permit Number and Date Issued
C. ,�Renewal Before ❑ Revision �Change of Plumber ❑ Transfer to New Owner �� ��� � O
E�;�►� . 2 �-
N.Dis ersaVfreatment Area and Tank Irtformation:
Design Flow(gpd) Design Soil Apptication Rate(gpolsfl Dispersal Area Required(sfl Dispersal Area Proposed(sfl System Elevation
�v v�? �� aa� �'3,�
Capacity in Total #of Manufacturer ,
Tank Information C�allons Gallons Units '� o � �
New Tanks Exi�ting Tan1cs � � � � � ,� � �
cL C� v� v� a. c� o,
Septic or Iiolding Tank NU yU � �✓i e5� N
Dosing Chamber S-�� �� � L�,/�E'S,<.J� X
Y.Responsib�lity Statement-I,the nndersigrte�l,assume responsibitity for irrstallaUon of the POWTS ahown on tke att�c6ed plaas.
Plu 's Name(Print) Plu 's Signature MP/MPRS Number Business Phone Number
os.s �z��,��, _ — ya s�s �,S- z����33
PlumDer's Addrtss(Street,City,State,Zi Code)
aytt�i ��r� ��Q i��c� L�Y..� w� 5�ia��� a
YI.Couaty/Department Use Only
i Permit Fee ' Date Issued Issuing A�ent Signature
��.App �Disapproved
�7„� $ 15e,•d y c � !�3 �",1��<'+��,��, +-r,��
❑Owner Given Reason for Denial �
Conditi s of ApprovaUReasons for Disapproval
� , � _ . _
� „ _
,�"'� � i � s .� _ �,. -, ,:
_ ._ �_. _,n_ ..___.. �. 1 ,�f
' _ i`
� ,
� � ��� ��13 �. ,��'�/ �-��-- — -----� �
t�hk�$ _ � �;� � s
� �� �.�:� 3�� �'�'�;r� p 4 2023 ��
�S l �� - 2-S`g � �
. ,.
, ��
,--- _ _ _
�,R'JVY�R COU�TY �
Attaeh W camplete plsns for t6e system and�nbmit to t6e County onFy on paper not lean than 8 V2 z il �
i �0 /V
SBD-6398(R 02/22) NC R�FtJN�B AFT�R
I�SUL=OF f''�t��lli'!1
PAGE 1 OF 5
In-Ground Dosed-Gravity Plan
Index & Cover Sheet
Component Manual Design References:
In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
Pg 1 of 5 Index & Cover Sheet
Pg 2 of 5 Piot Plan
Pg 3 of 5 Dispersal Area Cross-Section & Plan View
Pg 4 of 5 Pump Tank Specifications
Pg 5 of 5 Management Plan
Attachments: Enclosures:
Pump Curve POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description
Owner Name(s): �� � 5��'' v���^5"'� Phone: - -
Owner Address: 1� (o`��`i ec�t� � fl v�c+��+w1i� � Zip: �3`�U
Project Address: ;3bI� !� �(.�.��� �u 1�1 rt��-�`X� �-'� �,'�/�
Govt. Lot: � .1/4 of � 1/4, Section �� , T -�N-R 9 E ❑or W Q
Township: LJS�'�`x'� County: �t�y�-�
Project Parcel ID #: S�-O`� 2- j� -�S -Z?-5 15-�1� 15Cx��t
Designer Information
Designer Name: ��� ��-���� Phone: ��S - �S - ��33
Designer Address: ayUy ay �" �vR �Le l�e <<�� Zip: 5����
E-mail: �c�'Tu,�.„�H� i��C c�.�l' �co��
License Number: ,��a Si�S
Remarks:
Signature: - � Date: /U-`�73
Original signature required on each submitted copy.
IN-GROUND DOSED-GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down-sizing credit)
�
��_�' -��___+
;�.';,�;,; TYPICAL TRENCH
SOILCOVER CROSS SECTION VIEW
t a'
mn ne� (NO SCeI@)
a'P�
fNq�l .
F"--�e' ":e •
��Y'"��� � Provide minimum 3 ft
�� separation belween Iranches.
System Elevatlon=93•5 fl
(rypical)
Ouick4 Standard-W
w/End Cap O�servatlonPme
�ryP���� (Show location of inlet/outlet pipe connec6on on plan view.) �Nu� TYp�CAL TRENCH
inainli vni manrtMaurerc
���n«�s PLAN VIEW
r ------- ---��--- -----�f- ------ —� (NoScale)
�� . . . � TA=3.Oft
L-------------7'/�- ------��---- -------� �' Mp��l
�
i -- B= � ft � �
�HP���) Quick4 Standartl-W Chamber m
INSTALL PER TRENCH: �typ`��� C.o
(mre ey��fitlraw,sys�emc,�na) O
11 ��:t��Purwem�o me�Wxwrerc��sw�uor�:.
Qulck4 Std-W�20 ft'EISA/c�amber= 220 ft' -�
+ � Pairs of end caps @ 6 ft'EISAlptir= 6 ft' �
=Proposed EISA per trench= zzs ft' Required Infiltrstlon Area= 215 ft' DiSlfibuti0n MethOd:
x � trenches=Proposed Total EISA= 226 ft= Pressure manifold �
�
L
W840/500—MR
_ _ _, TANK SPECIFICATIONS � y
-- --
n� 5�- � ,
a
' OIMENSIONS: a �
WACL• 2 9/16, a
4'� CAST'-A-SEA��� � r 4" CA�r_.P.-SEAi_ I
� BOTTOM: 3"
. _ . . - ---_ ._ ._
- �rc .-� COVER: 5' . �.,I i
- �',� • 1 MANHOLE: 24' I.D. PRECAST CONCRETE RISER + i
�'�' ' �i�� z ~ . � � HEIGHT: 59 1/Y " -�
� :i�� � _ ���� c°; ,,`:c �/ LENCTH: 9'-5 3/4� W
i� g1�� ��i�- " WIDTH: 7�-9' rc
/L` I �1'.i :t �
'!'.";` . . 1.1 '. �1 BQ�W �N�T: � _ '_ �
`-� , � , :'� ' ';1- � �y uQuio �vE� a3- � IE
j � ,�- WEIGHL• 77,150 195. a) o! o
� . ��� � •':1� � _ _ �I �� V o
i �i!., ' INLET AND OUTLET: 'p � o �
� F!�TER (9i-� t"i r�', 4" CAST-A-SEAL BOOT OR EQUAL GASKET � �� o 'a
�
i. BAFFLC ��i' ir _ o m
I �:, i��; ,; ='� INIFT AND OU7LET 8AFF1E AND FIITER: K � � �y
I �-�- - _._. __yt__'- WISCONS{N, SEE D£?All /1 D " � a
__ �� o a �
� - -- - ` . (OT}tER STA7E5 SEE CNART) W o
UWID CAPACITY: 19.81 CAL/IN {SEPTIC) ~ �
TOP VIEW 11.82 GAL/IN (PUMP) �W„ �
yY <�
LOADlNG DESIGN� 8'-0" UNSATURAIED SOIL C � `.f
O c;
TANK CAN BE USED AS: '!.0' � �
� SEPTiC/SEPTTC, SEPl1C/PUMP, i `�
�v
N� OR SEPTIC/StPNQN � � r'�
� o r a"' �JEN�
� COVER: MIX DESIGN /8 (NO FIBER) ej' 3 ��
� TANK: MIX DESIGN /10 (STRUC1URAl FIBER) _ �''
_. .. J'n-__ . .. ._.. . � �
.. ry-. ..�—yt�� -� CUSTOMIZED TANKS: D
�-- __ � � ` Il —L FOR d1STOM TANKS CONTACT WIESER CONCRETE �
� IUI� � _ _ 1 _, _ Utaitl !
_� 1 - - - -�=-_ �
� � � ,, ; t i ;; _T- � � . � i
�n a r; . � � � ,�
� �I .. i i 'n � � v
�, ;, �:, � �� �n� �� �* � � �. W a --'
i � � � v ., � ¢
� ) ' g � " �a � I � Z
?1'- ^- i � � �
t ' � : I , � oo a
_l.__.1 .. ..,- . . L _1 . . . � .; s_�Lr_.--�,s' N �
. -- - __
� REVlEWED BY o U
�> ":, p'ry REYIEW DATE � a
� wEw DRAWINGS SUBMITTED �
FOR APPROVAI
arvzm[n 9'+: - ------. . s�+�ET r+o
Ai?R(WAl �.1TF; � ��
_ .__._.—__ —.
vRQC��riS v[(p[P ¢*: ��'
TANKS ARE MANUFACTURED TO MEET OR EXC� ASTAA C-f227 REOUIREMENTS '-"��-'"'" �-"� � �
SEPTIC TANK AND PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
� Vent Pipe �ocking cover with
> 12'above grade warning label and locking
� device and sealed �Neather Proof Junction Box.
Electricai as per NEC 300 and
SPS 316.28 WAC
Disconnect � 4 in
� -��
r �— Alternate
18"min. outlet
1 Force Main 2„
( Diameter:
Aoproved Length Q'�1
Building effiuent filter �
to 1/8"
sewer partic�e size A
Weep hole or anti
Polylock - PK S siphon device.
a
c
.---
Pump Off Elev. $��23�
D
♦ Dose Tank Elev.87•4��
aed Tank Nate: All pipe and vent materials comply with SPS 384.
Anchor tank as necessary to negate buoyantiorces.
Tank Manufacturer: W�eser poses Per Day: 5
Tank Sizes: Septic 840 Gallons GPD/#of Doses: 30 gallons
Pump 500 Gallons Backflow: 6•52 gallons
Gailons Per tnch: ��•$2 Total Dose Volume: 36.52 gallons
43"
Liquid Level: Required GPM: 25
Pump Manufacturer� Liberty . Dimensions � Inches ' Gallons ;
Pump Model: 250-3 series A . 27 319;14___j
� B 2 : 23.64
Alarm Manufacturer. SJE Rhombus '�_ C 4 ~ 47,2$ �
' D ��� 10 � 118.2�
Alarm Model; HW 101 �-�Total � ������-� j 508.26
Vertical Difference between pump off and distribution pipe - 5.93'
Minimum Required Supply Pressure (0 for dosed conventional) _ �
40' Feet of force main x �-39 friction factor! 100 = 0.6
Total Dynamic Head - 6.53
��
� �, �' .-...,F,: `
ber Pum s ��=��� :
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.:�� � ��-
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� .. .;��
LITERS PER MtNUTB
;
0 `� �� 2u 40 50 SQ 100 t20 1�0 160 160
25
. ____ ..., _. . ..___ 7
20
6
_ :
,
, �
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5
15 �
W
M^ ......_.. __.._—___..__._ __,.__—
W y S
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Z . _ _._., q ?
_ _. _ Q
'Q . ...__....�.._....--—_.. _..... .. ... W
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= J
Q . .. _ ____'_'___ .. .__ .. �
F Q
Q ,�O F
3
_- -- _' f
2
5
. t
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10 2C 30 ___40 J��
GALLONS PER MINUTE
'_SU_P�Ri�17�iUig �i�lbpyiiphiluiBLilunylhin,p;lnc :Vlii;;h�sic;u�ed Spceiiie;ui�ns:.uhjecuoehnngewithoutnotire ���
Pumps�
���������� PL-525 Effluent Filker
Innownvmi�Rnan.An�a9� �y 71�1"
bWntewnnProdu.n I APn.�mnt�atmc.
PL-525 Filter
The YL-525 Fil[er is rated for 10,000 GPD(gallons per dav)making it one of thc large�t filter.�in its dass.I[has
525linear feet of 1/16"'filtration sloCs.Like[he Polylok PL-12Z,the Polvlok PL-525 Fu�s an automahc shut-off ball
instalied with every filter.When the filter is remoeed for deaning,the ball will Flcat up and temporarih�shu[off
the system�the eFFluent won't Ieaac fhe tank.
F�amres: 7C16"Filtration Slots
•Ra[cd Eor 10,000 GPD(gallons per day). �--^�an^swimn
10,000 GPD �O°"°"'9
•525 linear(eet of]/1G"(i1M.tion. _
� n«e�.i�i"rve
•Accepts 4"and 6"SCHD 40 pipe. � F.rtens�on I la�dic
•[iuilt in gas deflector.
•Autumatie shut-off ball when fil[cr is removed.
•Alarm accessibiliN. Ra�.d r�r
IO.Op)GPD
•Accepts PVC extension handle.
PL-525 Installallon:
Idcal for residential and rommcrcial waste flows up tn 57v t.inca.Ft.
lU,P011 allons da� CPD. "�l��fi
6 F� }( ) F�inano�5i���.
1.Loca[e the ou8et of the septic tank. �.
2.Remo��e the Gink cover and pump tank if necessarv.
Accepts q"k h"..—�
3.Glue the(ilter huusing to[he 4'"or 6"outlet pipe.If scfin au p�pe
thc filter is not centered under thc atcess opeaing usc a
Polylok Extend&Lok or piece of pipe to center filter. •� -
4.Inser[the PL-52�(ilter into its housins. ' "' """`
5.Re lace and secure the se�tic tank�over. 6e.tiflee to
P f � NSFIANSI Standard 46
Pi.-i25 Maintenance:
Thc PL-525 Effiuent Pilters will operate efficientl}�for --��� -___
sceeral yeazs under normal conditions before rcquiring .. . l%�
cleani�g.It is recomrnended that the fil[er be deaned . . �
every time the tank is pumpcd,or at least every[hrec
vcars.If the installed filtcr contains an nptional alarm,
Ihe owner will be notified by an alarm when the filter
needs sen-icing.Servicing shinild be done bv a rertified '���`��"����
septic tank pumper nr installer. � = nu:�.man�
�nu�-J�r tt.,v
1.Locate[he oudet of[he septic tank. �
2.Remove tank cover and pump tanlc if necessary.
3.T�o not use plumbing when filter is removed. 1'1�
d.Pull PL-52�carh'idge out ot the housing. � ._-�-:'
5.Hnse nff filter o��cr the sepFic lank.Make sure all E `
solids fall back in[o septic tank. � 3A�`
1__.��,_,..ir
G.inscrt the filter cartridgc back inro the housing makins
nuldn��r Smartl�iltrr��:\larm F�Icnd&I.nI;'�a
sure the fil�a is Froperl��aligned and com}�letelV in5erted. poh�ink,Zabel h Pesr fitrcrx a«�pr t s�ic�o«au.
7.Replace and secure septic lank crn�cr. ih�•SmariPilt��-wit�h<nd ald�n. inw existing r nk..
Pulylok.lnc. 3 Fai�eld Hlv�i. VJallingford,Ci 06J92 Tiill Frcn:877.7659565 F;ix�203.2H4.8514 www.polylok,com
N LE DG E!V D
■ = Soil Pits wlth Backhoe
= Benchmark Elevation = 100.0'
-Nall nionnpe ribbon in 20"dou6le oak tree
— — — = Property line �
SCALE: 1" = 30'
�2ar �
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Driveway Garage I
Z
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t� I
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� House I
U I w���
z � I
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, _ _ _
oto � — _�� � — �_ Existfn9 sePtf4filter tark
100.0'� — I
� B2
_ —� '_ � �500.0� — — �
1 1 �
B1
9�.0�� � _ �9Lo.� _ _ _ - - - - - - —
Z'SchaC Or� m .nui.net�.c�s ��Y1��E-- •.—•
9 �+ 1 — — — — — — �.�infield for 3-eedro _ �
� _ v°�B3 � EXistin9 � �
w..-�,.�orsa• � � I
wr���r�,,,rnp;a„t '° 96.4' � � .
93.1'� � a��xna�v.� - - - �e' - - - - - - - I � � . � ' ' • • • •
I � .
Cabin � , . • '
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I — — _ — � SteeP �
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Lake Elv. 75.1� �p,KE �HETAC
-- �;�55 �i�vc)�5 --- I �u�,�j � 5(..�/ii cviC�/
Ci�.�#1 �7 4a 9J�5� �.j141.: C 1„3<d- L K 2 S W
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,�r.rca� » -w� - z-33 -b9-z)-5
PAGE40F4
In-ground Dosed-Gravity Management Plan
IMPORTANT:
The owner of this in-ground dosed-gravity system shai� be responsible for ils 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 health hazard if not maintained in accordance with this approved management
plan. Furthermore, ali inspection and maintenance activities shal� be performed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3),Wisc.Admin. Code.
Maximum Dispersal Area Operatinq Limits:
Design Flow= �� gpd; BODS<_ 220 mgL"'; TSS <_ 150 mgL"'; FOG <_30 mgL''
Inspection Checklist INSPECT EVERY 3 YEARS
type of use
„ age of system
nuisance factors(i.e. odors, user complaints, etc.)
„ mechanical malfunction (i.e., pumps, valves, switches,floats, etc.)
, malerial faligue (i.e., leaks, breaks, corrosion, etc.)
solids vdume in anaerobic treatment tank(s) and any distribution appurtenance(s)(i.e., distribution/drop boxes)
neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.)
. extent of ponding in distnbution cell prior to dosi�g
dosing irregularities-if applicabie(i.e., pump re-cycling,float switch settings, etc.)
electrical components- if applicable (i.e.,winng, connections, switches, controls, timers, alarms, etc.)
_ distribulion lateral or lateral orifice plugging (measure lateral distal pressure-compare lo design specification)
surface discharge of effluent or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Septic and dose tank(s)shali be pumped by a certified septage servicing operator licensed under s. 281.48 W is.
Slals. when the volume of solids in the tank(s)exceeds one-third (1/3)the liquid volume of the tank(s)or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113,Wisc. Admin. Code.
c, Effluent filter(s)shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12
months.
System mai�tenance 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: � �7/w./yT /N� Phone: 7��"ZUS -�/I�
Localgovernmentunit: � C_u.-,� Zu:�iH� Phone: 7/5- �31i- }jZ��
I
Lxal govemment unit address: I/��el f�r.�� 5�- �- � �/S ���� W� ZIP: ��l��i 3
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (t), 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 uniess approved by the department in
accordance with SPS 384,Wisc.Admin, Code.
Continaency Plan
In the event that any failed treatment componenl 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-complying dispersal component in a pre-determined area of suitable soils,
Svstem Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33,Wisc. Admin. Code.