HomeMy WebLinkAbout012-740-02-3207-SAN-2023-296 c'"�`"�'�.,, Department of Safety � �
��'k�! ���, &Professional Services, .5 Aw Y ER �
!=; ' � - Sanitary Permit Number(to be filled in by C
',i�� �� Indnstry Services Division �_ �
��,�f� t� 5 I � �� W
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Sanitary Pernut Application StateTrdnsactionNumber �
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this fotm to die appropriate govemmeotal imit .�
is required prior to obtainmg a sanitaty permit.Note:A�lication foims for slataowned POWTS ere submitted to Project Ad�ess(f diffcrent than maeling ad 6'
t6e Department of Safety and Professional Services.Personal iaformation yov provide may be used for sec:ondary
pucposes in accordance with the Privacy I,aw,s.15.04(1 xm),Stats.
r.Applicatf�n Informatios-Pleas�Print A�Ia�urmatiea �T SS.�N SuMME�cS Pr. L�.
Property Owner's Name Pazcet# O�'.-��{Q_��- 3 2 b�
l�AQ10 �' IQ��EE /�/ A.1DA S7- D!?-.7`Yo-67-G1-J 6.?-coe-aes.7e
Property Owner's Mailing Addtess Properi �n
/8�3 /,�1 r.�ooa Lr f�``, c
City,State Zip Code Phone Number
Eaa C�A�R F l,�l I sy�b.�
N�r��., nr w ��., s�►� a
II.Type of Bui�ing{check ait t6at aPPly) Lot# �3 T 'y0 N R E
�1 or 2 Family Dwetling-Number of Bedrooms .3 Subdivisian Name
Blcek# —�
�PublicJCommescial-Desc.�nbe Use ,_.--
D Ciry of _
�State Owned-Descnbe Use CSM Number�.��j/3 4 �Village of _
�Town of �u�r r�R
�9 �30 —
III.Type of POWTS Permit:(Check e�ther�New"or"Rep}rceane�"and other appticable on lfine A. Check one boz oa line B.Comple�e lin�e C
s licable.
`�' �New System ❑Replacement System g y ( p ) p )
❑ Other Modification to Existi❑ S stem ex tain ❑Additional Pretmatment Unit(ex lain
B' ❑Holding Tank �Io-Ground ❑At-Grade ❑Mowid ❑Individual Site Design ype )
❑Other T (explain
(conventiona])
ist Pcevious Permit Numbcr and Date Issutd
C• ❑Renewal Befo:e O Revision ❑Change of Plumber ❑Transfer to New Owner
Expuation '��—
iV.Dispersal/Treatonent Area and Taak Information:
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispetsal Area Proposed(s� System Elevation
ySo .S 9aa 93�.� 93•.� '
Capacity in Total #of Manufacturer
Tank Inforroation Gallo� Gatlons Unita ,p � o'$ �
New Tanks Existing T�ks �n�i C 8 � � .�070 � �
cC U° v� � rn c�.C7 O.
s�nicor����=.4 �Q�O — /d00 � /�4fi[urT �a.1t,t.
r-
n���cn�,�� G aO - G o o ) Lc r�,da '�
V.Responslbility Statement-I,the asderaigned, me reaponai6il[ty foriasnDattoa of the POWTS ahown on the attae6ed plans.
Piumber's Natne(Print) Pl 's S' MPRr4PRfy Number Business Phone Number
C Rr oo � 8y�37O 7�S 93.�-d'Yy3
Plumber's Address(Street,City,State,Zip Code)
G y3/ l0 � d�. 10 o F�c lJ Sy7��
VI.Cou Nepartment Use Ualy
�A e ❑Disapproved Permit Fee Date Issued Issuing Agent Si�amre
❑Owner Given Reason for Aenial $���'� �� ' � I�3 ' " I'����
Conditions of ApprovaUReasons for Disapproval �
�� � � � -'- _w...�.�.�i.� 3 - � l.� _�
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CSYT �3 —�.o I .���*'�.��----�---�-----�- sawY�� co�vrr
ZO�VING ADMfiVISTRATiOt�
Athch to e�pkte plam for t6e sy�tem ud wbmit ta tYe Caanty only oo paper uot less ri�n 8 1/2 x 11 inchn ia dze ���_j '1 '7
SBD-6398(R.03/22) �C R�i1N��'s r'�7'FR
iss�.��c�=r��vrrr
Page 1 of 7
Private Onsite Wastewater Treatment System
Index and Tifle Page
ProjectName: /-AQLa � /�ENEE /''/.SA�4A � 3-f.�.�. �.JL�o4.rolPu,v�° Pa�rrs c,�/E�r)
a �� r�
Owner's Name:
Owner'sAddress: /8�?3 /,✓r.�oao Cr.
EAu L[.vi�F 4JI sY�o3
Legal Description: NlJ. N�•1, .T, 5/o N 7 t<1
Municipality: Town, V..�ge, C�of ,�ur rr.t
County: .SAw Y��t
Lot Number: /3 Block Number. CSM Number: 7y39
SubdivisionName: 9SS.7 N. Su�r,+�Rs �ai�+Y L�.
Parcel I.D.Number: 57-ai1-.�- �'a -a�-aa-3 a�-aoo- �00070
Page 1 Index and Title Page
Page 2 Plot Plan with Cross-Section&Plan View
Page 3 Septic Tank/Pump Chamber Cross-Section&Specifications
Page 4 Pump Performance Curve
Page 5 POWTS Owner's Manual&Management Plan
Page 6 POWTS Owner's Manual&Management Plan
Page 7 Filter Information
Name of Designer: Cu,c r �oa s License#: /'!P- 8Y1370
Signature: Date: /o-3a-.?o�3
Des�ig�ed�ursuant to the followingPOWTS Component Manual and DSPS 381-385:
"In-ground Soil Absorption Component Manual for POWTS"Version 2.1 (May 2022-202'7)
Attachment: Soil Evaluation Report
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Page 3 ofi 7
COMBINATION SEPTIC/DOSE TANK CROSS-SECTtON
(DRAWING P10TT0 SCALE}
FIt�lAL GRADE ��HOLE RISER 8�COVER
(per S'PS 384.25(7)8(8).approved
(stope ground sixFaoe away from bdcing devi�.&waming label:Extend
manhote{s)for Faoper drairqge} manhole riser as necessary.}
4'IuRn.Sch.40 PVC Tank Vent
ELECTRICAt ��1z'a�e graae°�24'
a•nn�n.saL aa Pvc rank v�,c JUNCT{ON BOX �Re�°"a�fl°°d se�au°"
BUlLDINGSEWER locatedl2'abovegradeor24-
{per SPS 38230(11)} above Regia�al Flood Elevatlon (�WY�SPS 3'16
and NEC 300}
!
FORCE
. . . . . . . _ . . .: . . - . " . ��r -
MAIN
'�' : >a- �PT10NS
�,
�,
�
� •.-.-.- •.. . Iss'crnrar �� --
. �� >18'
� ��
'` „23-min_.' ��
>18' ��� �� + Force
t�
f �'.'.'.'.'.-.'.'.'.-.'.'.'_'. �� '.'.'.'_'.' � - • �
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eorrow oF iru�r�uwen e�auon� �c Tf00— W���
3 Hoie I „
�rotFr—
(wascewater�av - - - - - -:�:,- - -.���:�— \
^"'�'""��' vvReserivE Fropaysmea
N� �CAPACIy wl�enml�ae0
Es r'
n : � _"3 °^
y7 - .� l,f-!o / �: �,,,��
� On Flo:rt
+•un.e'r w� APP�ed EtAuaM Fdter a i
�a�� 55GPmtideS¢e
Requeed On Oulei Ofl Fbat
A �ev._
- - - ,.a rt
N►iNiMUM OF 3'QF SUITABLE BEDDlNG BEWEATH TANK 8 MAXIMUM BURY DEPTH OF 96`
Mcttoring�fi tank mey 6e required per SP5 383_43(8}(9)
Tank Manufacturer: l�ufftusr �„�c,cF�E Daily Wastewater Flow(DWF): �/.Td GPD
Septic/Pump Size: /ocr�/doo aallons Humber af daify doses: .5 3 (� /8.r 9e�
Alarm Manufacturer. ,SE�T�ca�rre s
Model Number. �'t.1'.T( Force main volume: 90 ft x _/63 gaiift= /X 7 gal
Switch Type: /YEr.�/,4,,��cwt �al dose volume: 99 gal - /X 7 ga!= 8 y 3 gal
(total dose vofume-volume of force main)
Effluent Pump Manufacturer. /7rE�ct
Model Number. �E 3F �SE TANK CAPACITIES:
Reserve above alarm d 5.S in= 388.Y gal(D)
Minimum Discharge Rate: 0?0.0 GPM E11arm float above on float a in= .�o,S gal(C)
�NOff float measurement �•s in= � gai(S)
Verficai lift(pump off to lateral invert)....._...... /?•� ft OfF ahove tank bottom_�_in= ���8 gal(A)
System head (distal p�ssure x 1.3 ft)_ -- ft
9d ft Force main x /.o /100 friction factor , 9 ft ppSE TANK DIMENSIONS:
Fiterfriction loss...................................... — ft Length /'Yd in Width 7`� in
Total Dynamic Head(TDH): /� � ft Outiet height `1a in Gailonstnch 15�3
p�. y 6� 7
MYERS� M E3 S E R I ES
..
Capacity liters per minate
0 50 100 350 200 250
40 32
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30 ... _ _ . ,S.p . .
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0 10 20 30 40 50 60 70
Capacity gattons per minute
�PENTAIR
Page s of 7
POWTS OWNER'3 MANUAL AND MANAGEMENT PLAN
FILE IIVFORMATION SYSTEM SPECIFICAITONS
Owner PR�![o r ENEE i'/i,cA„10 A S tic Tank ci /Qa0 at O N
1 Pertnit# S tic Tank Manufacturer uff'�u s r Q N
DESIGN PAIiAMETERS Eftluent Filter Manufacturer �B ES r O N
Number of Bedrooms 3 Efflueut Filter Model j,f-/O O N
Number of Commerciai Units �- pum Tank Ca aci : f b0 al O N
Estimated flow(Ave)(100 gpd/bedroom) ,30 Pum Tank Manufacduer uiFcu rs O N
Design flow(DWF)=estimated x 1S �j/,fQ Pump Manufactuner My��s O N
� 5oil Application Rate ,.s d/i� Modei �E 3�' O N
Influent/E$luent Quatity(l7 NA) Monthly Avecage ���e°t Unit (�NA)
Fats.Oil&Cuease(FOG) <30 mg/I, D SandlGravel Filter O PeatFilter
O Mechanical Aeration O Wetiand
$iochemicai Ozygeu Demand(BODS} <_22p mg/I, p pisinfection O Other.
Totat Suspended Solids(TSS) <_150 mg/I- Manufacturer Model:
Pretreaied Effluent Quality(�NA} Monthly Avecage Soil Absorprion Component{O NA)
i Biochemical Oxygen Demand{BODS) 530 mgjl, ��-�ound(gravity) O In ground(pressurized)
Toml Suspended Sofids(TSS) <30 O At-grade O Monnd
Fecal Cotiform(geometric mean) <�p��1�p0m1, O Drip-line O Other.
Vertical Distance TankBottom to Service Pad: R
Maximwn E$luent Particle Size i/8 inch diameter Horizontai Distance T s to Service Pad: ft
Dispersal UniE MfgJModel Nnmber: O NA
Calcolatfons:
Sail Dispersal End Cap (Dispersal Unit EISA)
i?WF — Application Rate = Area Required - EISA — or(Trench Widtti) _ #Uniu or Tatal Len�tt►of Trench(s�
`�5O = , s = 9ao _ y�,�3) = ao.o��• = y� ��r��a E.�s (933.,7 fr`)
DESIGN CRITERIA �7.x f.�
O"At-Gcade Companent Mam�al SarPOWI�" (PrEssure or Giavity.Version 3.0(May 2022-2027)
C7"Design of Pressure Dis�ibution Networks for Septic Tank-Soil Absarption Systems." Publication 9.6(SSWMP Manual)
O"EZ Ftow Mound Component Manuat"Veision 12/I5/2017(Apri12018-2623)
�"7a-Ground Soi!Abso�,siion Componeat Msnttai far POWTS"Version 2.I (May 2022-2027}
0"Mound Component Manual for POWTS"Version Z.1 (May 2022-202'�
O"Pre.gsure Distriburian Component Manual for POWT'S:'Version 2.1 (May 2022-202'n
O Orher:
MAIIITTENANCE MONTPORING 3CAEDULE-rIAIIVTENANCE AND MANAGEMENT
Service Event Serv[ce en
Pum /ias ect di ersal ceil(s,cle,an filter At least once ev : � 13 months �3 ears O Other:
Ins ect um & contro]s,aia�, ent unit At least once _ O months �3 ears O NA
Flush and ressure test laterats " At least once ev . O months D 3 �rs �NA
�TART UP AND OPERATION: For new construcrion, prior Lo using the POWTS check tieatrnent tank(s)for the preseace of painting
pnoducts or other chemicaLs that may unpe�e the ttea�pro�xss andlor damage the dispecsal cell(s). ff high wnc�tratinns are detected have
t6e contents of the tank(s)removed by a soptage servicing operator pria�r to use.Spstem startnpa�aQ�t�r�rhen soil coaditioss are truzen
at tlre i�ttrative snrfac�
The properiy owaer is respons��ble for the opeia6on and maiatenance of ti�e FOWTS and submission of required reparts. T6e cr�antity and
quality of the wastewater stream will affect the perfo�ance and Iongevity of yonr POWTS. The installation of water-saving aggliances and
Eix#ures aiong with prompt repair of leaks reduces the wastewater volume. Also the brine or waste&om water sofreneis,ffon reanovat units,
other clear water treatment devices and foundation disins should be discf�arged w the ground sarface wheaever pos�ble.Note:this does not
include la�mdry waste,showeis,dishwatea,�c.
This system is desigaed to ban�dle domestic strength v�astewater,hawever,the dispasai of food based greases>oils,vegetabie/fivit p�ls,
seeds,hones,and food solids,such as tttose produced by a gsrbsge disQosal should be minimi�P� Toilet tissue is the only paper that should
be discharged into the system.Other non-biodegradable items.suca as baby wipes,tampans,saaiffiry'napkins condoms,cigarette butts,
dentai floss, and eotton swabs, shonid not enter the systmi. Chemicals, such as getroleam produats, Paint, disinfectants,pesticides,
anhbiotics,salvents,etc.,shonld not be flnshed iatothe system baa�they can serionsiy damage yourPOWTS and coataminate your
drinldng wat�eer suppty. Maintain a�gttlar steady flo�r by sgreading latmdiy wastung throughout the wcek Avoid vehicle tr�c over
all system componeats_Comgaction ofsnow over the dispersai uniia�ay cause it to freeze nP•
disinfectanLs,pesticides,antibiotics,solvents,ecc.,shouid not be flushed into the system as they can seriously damaoe your POtiVTS
and contaminate your drinking water suppl��.
Maintain a r�gular steady tlow by spreadin�laundry washing throughaut the week_Avoid vehicle traf5c over all system components_
Compaction of snow over the dispersal unit may cause it to freeze up.
INSPECTIONS&Ii+�.IlVTE�tANCE:Inspection shali be made by an individuat carrying�ne of the foilowina Iicenses or
certi$cations:Master Plumber,�Ias[er Plumber Resuicted Setver,POWTS Maintainer or Septage Servicing Ooerator lner the 1rr;,�t,��i
:�iGi❑icriance Scneauiej. i ank Inspec6ons must include a visuaI inspec7on of the tank to identify any missing or broKen i�ardware,
identify any cracks or leal:s,measure the voltune of combined slud�e and scum and check for any backup or ponding of effluent to the
�ovnd surface and test a11 eiech-ical equipment such as pumps and aiarms.Any defects shalt be promptiy correcte�Exposed openinEs
graaier than 8 inc�es in diameter shall be secured wit�effecave locldng de��ices to prevent accidental ar unauthorized entry the tanks.
VVhen the combination of sludge and scum in any tank exceeds one-third(1/3)or more of the tarilc volume,the entire contents of the
tani:shall ba removed by a Sepfage Servicing Openmr and disposed of in accordance�vith ChapTer NR]13,b�risc�nsin tldministraiive
Code.
i he outlet fitter{s}shall be inspected and cleaned t6 r�move any accumula.ed s�lids accordin�to manufacturer's speeifications.Solids
tvashed from the filter shaII be retained in the tank.Filter cleaning may be necessary at more frequent iniervals than sYated in the
rnaintenance schedute to keep the system operating.
Alarms should be tested on a regular basis by ihe home owner_Tf an alarm sounds,contact an individual licensed to sen�ice PO�VTS,
Tltera is normally a 1 day reserve underregular operating conditians,however water should be conserved unti(any prohlems r.vith the
system ar�corrected to prevent back-ug of sew�e in*o rhe d�vel?ing or surfaci�a_
:���E3IRridl�.l'Ia: lVhen the t OW!S fails and1or is permanently taI:en out of sen�ice the folio�vin�steps shaI]be taken to ensure
that the system is properIy aad safely abandoned m compliance with Ch.SPS 383_33,Wisconsin Administrative Code.
- AII pipin�to tanks and pits shall be disconnected and the abandoned pipe apenings se2led.
- The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicm�Operatot.
- �.fter pump[ng,all tanks and pi[s shall be excavatPd and removed or their covers removed and the void space filled with
soii,gravei or other inert soLid material.
�:�I�T�L�'GEti�Y t LAtZ:if the PO4VTS faiLs and cannot be repairad the folloa�in�measures liave been,or must be taken,to provide
a code compliant renlacement system:
� A suitable replacement area has been evaIuated and may be utilized for the tocation of a replacement soil absorption systeu�.
'!:��4.'.ce,T,.�,t a,-c�s�ot;';���:ratc�tcu Lur�t u'isiucuaric�aisci;:ompac��n anri snouid noz be ni;�n�ed upon by requt.eci
setbacks from existing and proposed structure,Iot lines aad cve]Is.Failure to protect ihe replacement area render it unusable.
Replacement systems must camply with the rules in effect at the rime of replacement.
!_'1 A suitable:eplacement area is not avaiiable due to setback and/or soil limitations.Barring acivances in PO�'TS technoiogy a
h4ICItR�tank may be instailed as a Iastresort ta rzplace the faiied POW"tS.
The site has not been evaluated to identify a suitable replacement azea_Upan failure of the POWTS a soil and siie evaluation
must be performed to locate a suitable replacement area If no replacement arza is available a holding tank may be installeo
as a last resort ta tzplace the�ailed POu'i 5.
Q �v?ound and at-�rade soi]absocption systems may be reconstructed in place iollo�vin�reino��a�of the biotnai a�the infittrarive
surface_Reconst�uctions of Such systems must comply with the rules+n effect at that tim�.
«'VI�ARNING»
SEPTIC,PUMP AAFD OTHE3i TREA'['MENT TA�tKS�14Y C4hTI.'-�I4?�THAI..GASSES A��I2/OR IIvSUFFiCIEN i
O�GEN.DO NOT ENTER A SEPTTC,PT3A�IP OR OTI�R'�'�tEaTNiENT T4NK�ER AN�l��tC€JtlqST4tYCE�.
�D�,��'���I/RES'JL 2.RES��i QF '�PiRS��'�'+R`JNi�'i�E i�e i�RI€�'�.t��F1 a ANK 11%RA�'3��iDaFI+�CiT%i�R
Il�4POSSIBLE.
tiDDITIONAL CONflVIENTS —
P�b�t s S 31�ISTaL3..E�t FOih'i S�1ALNTA�r iZ
Name �u�.r f✓DoS /�1�-Sy?d 7o Name �u,cr a0 S
� i'hone 7/S 933-,t yY3 � { Phonc 7/S 933'.?yy3 �
SEPTAG�SERVICiNG(}PERA'i'OR(Pum er� ZO�A:..RiGUi.ATORSI Ai1'F�iORY'I'Y _
Name • Aaency SAwyf� ��• Zba�,�6
Phone Phone 7/S G�y- ?88
Pa�e�of 7
i
^�
� �
0
��
a Installation Instr�.ctions for the GF1� Filter Maintenance of the GF10 Filter
A tlmc frame In whlch septic tanks are serviced Is set by stute and Iocal codcs.
a�' --- f���' �'�•----��• � Althouc�h[hey may be dllierent,most regulatory agencles suggest two to five
years.We recornmend the GF10 filter be deaned when Ihe seplic tank Is normally �
cleaned and pumped,or as needcd.
� . . ;,: �... ,�
,
. ... •
�.._... .. ,,.. ' t" �s...._ .
. ( ` � ,.ei
' "�' WA6iNING: If the liquid level in the tank is above the top of the
.
� � � ' g he filter cartridge.
filter, pump the tank prior to removin t
Stepl:Locateandremove Step2: Beforelnstallatbn, Step3: Forinstallatlonsthat � CAlJT10N•USE RUBBER GLOVESWHEN HANDLING FILTERS!
the septic tank cover,on ` place che fiiter case on to requlre or desire adclltional �
the outlet slde of tank. the outlet pipe. Maice sure support. (I(additlonal support Is
the case is positloned so not needed,go to Step A) Glue a Step 1: Remove the septic tank cover .,e�+'"
the filter can be removed sectlon of 1"Sch.40 plpe to the and pump the tank If necessary to ,s"
from the tank for mainte- two hubs IocAted on the battom prevent any sollds from escapiny�o�he �"'`�` �
nance and servlce of the case and the hub I«ated field when the filter is removed. `;. )1,
on the side oF the case. �� � — ���`�
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Step 4: Glue the filter case onto Step 5; For Instailations wtiere it w1ll 5tep 2:Pull the filter Step 3;Whlle hold{ng the Step 4: Insert the cartridge
the outfet pipe.Insert the fiiter be difflcult to reach the ha�dle,place handle and slide�he flher filter cartridge over the back(nto the case makfng
cartridge Into the case.(Make 1"Schedule d0 p(pe into the tee on the out of the case, access opening of the tank, sure that It is properly
sure the filter Is completely handle and extend it to I�elght tliat will rinse the cartrldge oft wtth allgned and completely
Inserted fnto the case.) mnke It Qasy to remove the fliter, fresh water,Take care to Inserted Into tlie case.
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malce sure all solld materlal
,''���T falls back Into the tanic
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Installation of an � � '
� Same as a new system only the sepdc tanl: �
� existing systern. mustbepumpedpriortoinstailoNnn. �� � 7EGNNOLOGY
��3 Feitlield Blvd,Wallingtord,CT Ofr192
�i amc ti:::+ r^av a;�r� u.;� �r�u iRa.s u�o c;rt o�:a ��v� ww� r:a �:�: i:.r, c:�: i.�,{ wr.a w+N i�..:a ar,Li 1•877-795•Bb85 Fex:203-284•8614 � .