HomeMy WebLinkAbout028-542-12-5517-SAN-2024-007 _ Department of Safety c°°°` �
- � � & Professional Services, - �
�� = Sanitary Permit Numb r(to be filled in by Cc
= Industry Services Division
.; .. (.nSl � l � t
�
Sanitary Permit Application s`a`e T�°�°`'°°N°r"ber o
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit �
is required prior to obtaining a sanitary pernut.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address)
the Department of Safety and Professional Services.Personal information you provide may be used for seconda ���� �j,�.n„�.�_� ��
purposes in accordance with the Privacy Law,s. 15.04(I)(m),Stats. � �""�`�
I.Application Information-Please Print All Information
Propeny Owners Name Parcel#
L�1/ '� d o�� �o • �o�• $/
Property wner's ailing Address Property Location
� (iovt.Lot
City,State Zip Code Phone Number
Gaa '/,, '/e, Section ��
II.Type of uilding(check all that apply) Lot# T �o� N R as E o
� 1 or 2 Family Dwelling-Number ofBedrooms � I Subdivision Name
Block#
❑Public/Commercial-Describe Use
❑City of
❑State Owned-Describe Use CSM Number ❑Village of
g�Zs��SS� �To,�of Svrder (R.Ke -
IIi.Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C if
a licable.)
A.
❑ New System �Replacement System ❑Other Modification to Existing System(explain) ❑ Additional Pretreatment Unit(explain)
B' ❑ Holding Tank �-Ground ❑ At-Grade g yp ( p )
❑ Mound ❑ Individua]Site Desi n ❑Other T e ex lain
(conventional)
C• ❑ Renewal Before ❑ Revision ❑ Change of Plumber List Previous Permit Number and Date Issued
❑ Transfer to New Owner I, �
Expiration ��K• ,
iV.Dispersal/1'reatment Area and Tank Information:
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation �
�' �O � �• �✓'
Capacity in Total tf of Manufacturer
a�
Tank[nformation Gallons Gallons Units p � v v � � �
New Tanks Existing Tanks � o a; � � p "' "'
� �
a U v� �, v� u. :7 fs,
Septic or Holding Tank /O / � .�� j �
[ f9 r'�
Dosing Chamber / r r . � '
V.Responsibility Statement- I,the undersigned,sssume responsibility for installation ot the POWTS shown on the attached plans.
Plumber's Name(Print) PI r's Signature MP/MPRS Number Business Phone Number
��l 0 �S -!��
Plumbe Address(Stree,City,State,Zip Code)
0 �ar�l.� u?L �8�4°3
VI.C un /Department Use Only
�A � ` ❑Disapproved Permit Fee Date Issued Issuing Agent Signature
❑Owner Given Reason for Denial $ (�� ( �`��/�� �'�"��
Conditions of Approval/Reasons for Disapproval �� 5�
"�' ��► � �� ' � a_`��a`�.w�,,.�n � ��v` I '
�
� � ���� �� �� ___ ,
i�l�
�'J� ����.. �`! '� JAN 2 4 2024
� ST o2 � — ��� a�s
5AWY�R COUN"t'`(
,�p��N�qpt�AlvISTRATION
Attach to complete plans for the system and submit to the County only on paper not less tban 8 1/2 x ll inches in size �q y� '
NO RCFUNDS AFTER ��
SBD-6398(R.03/22) ISSUE OF PfI�MIT
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 Plot 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): ���.1 L I U4�1G1 ( (LI�.S� Phone: - -
Owner Address: 7�j i,l� . ��.f''U ,�L Zip: �Q(2��
Project Address: � A ��Iz1?7 ��ff�l2 ��.�2� �C� J`��s`7
Govt. Lot: _1/4 of 1/4, Section��, T��N-R QS E ❑or W�
Township: �j(��,Ir �� County: ����-f�
Project Parcel ID #: � �� �� � oZ- � S��
Designer Information
Designer Name: Phone:�`?��!��3
Designer Address: l�(`r Zip: 5�
E-maiL• c ��
License Number: ��b ,�dl
Remarks:
Signature: - � Date: �����—a'�
Original signature required on each submitted copy.
�
i
PAGE 3 OF 3
BAILEY
PROPERTY LINE
/
B2 � `
WELL 99.55' . ,�B3
�br; , ` ioo.3s�
r
y{ �.
GARA �IM. �;, 1%
2 BED �� 81
°�'�9.65'
� ��
�.ry_x
�"
N /
�
STATE HWY 77
� 40'
�
SCALE 1"=40'
�
,BM BOTTOM OF WOOD S ING �oa.o AILEY LIVING TRUST
765 IIARPER AVE
CLJRRENT INLET PIP ELEVA"I'ION 96.85' CARY,IL 60013
SYSTEM ELEVA ION 97.35' S092W ST HWY 77
LOT 1 CSM#1580
SIZING AT 0.5 S 12 T 42N R OSW
TOWN OF SPIDER LAKE
TREATMENT AREA WILL BE CL E TO PIN 570282420512505005000170
MNIMLTM SETBACK DISTAN FROM WELL
IN-GROUND DOSED-GRAViTY DISPERSAL AREA
Uniform Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down-sizing credit)
� �
""". ,r' TYPICAL TRENCH
(NP�cal)
SOII CUVER CROSS SECTION VIEW
»" (No Scale)
min.Ucnch —
depth '
��YPlc�l) '. u '
_. _ ..,. . . �_ .. _ -. . .o" ' .
' ' . '' ' • .a a.
f�_-- 34" . . Q. .. , .
(�vni��) `, � Provide minimum 3 ft
n ° • ' e
` separation betwPen trenches.
Syst�m klev�tion =��• 3s ft
(typical)
Quick4 Slandard-W
wl End Cap obsorvac+on n�Pe
_ ��Ypi���� (Show location of inlet / outlet pipe connection on plan view.) Inslall porYmanufacWror�s TYPICAL TRENCH
�ns��ur,nons. PLAN VIEW
- - - - -�j�- - - - - -- - --
� ,� (No Scale)
IMaupRr�x�bet�yr�e!#�eR f -- — — —�R+t�'rae�aw���+reae�Msl
� n� ( � � a �) �A = 3.0it
iM` 4 NipXrr ��►Ara�� (tYPical)
�dI M M I�A_A�1 k 1�N M M 1�.N11��W1i _. .` �. _. ..._ _._. � ___. _.._ � — —. -- — — .— — — —
�� �� �
�----- —_ B = !�.� ft �_.�.� ]'
G)
(typical) Quick4 Standard-W Chamber (T1
l�vn��.��i> c�
INSTALL PER TRENCH: �mrd �y �ot��trator syst�ms, �no.� �
�7 tnstall pursuant to m�mufacturer's Instructfons.
�_ Quick4 Std-W @ 20 fl' EISA/chamber = J UO ft� �
CTt
+ �_ Pairs of end caps @ 6 ftz EISA/pair = ,� ftZ
= I'roposed EISA per trench = ,,� ft' Required Infiltration Area = �C� fl` Distribution Method:
x � trenches = Propased Total ElSA = � ft' /,�r��� ��:'�a�
R�� ,T � .
PAGE40F5
GRAVITY-DOSED
SEPTIC / PUMP TANK SPECIFICATIONS
(No Scale)
4'0 Vent Pipe
>70 fl trom
Building Flectri�l must comply wdh
12 Min.or 2.0 fl ahwe SPS 316 and NEC 300 Exlend manhole nser as necessa
Established Flood Elevalion Wealherproof ry'
(�YPinl) A��d Juncfion Bax
IMPORTANT: ��� ����a�+�
Anchor fank(s)as necessary �ty����
Pursuanc to sPs 383.a3(8xs) —ca,a�a
4'btin.or 20 fl above
Eslablished Flood Eleratim
(Mp�9
�AiNigh�Seal
Finished Grade
' Gate Valve/
i�uick Discmne 1
CAPACITIES @�D. [� gaUn y .- �
Depth(in) Volume(gal) W�rO����
I
A p z ` 3i g —* p Min.Depth=��in
� I 1�dow r�a��
ea
B 2.� �!. '� A I Wa�ertightGaskel
[c] s q �3 l
� � �
� �O ��6 -B�- _o�
[� c] PUMP-OFF
*Pump Tank Liquid Level=�in ---�— �P —� ELEVATION= l„p ft
I Check
Valve
Force Main Diameter= 2- in
° �qx,�e INSIDE BOTTOM
B�* ELEVATION= �°CJ.� � ft
ForCe Main Length= �� f� 3����Bedd�rg Matenal Benea�h Tank
Important:Bury force main below frost line or insulate
as necessary pursuant to SPS 382.30(11)(c),W.A.C. 3 ?� ��`�� .������� ,
v�
[C]Total Dose Volume TDV =��gal/dose ��'
(<02X design flow-NO DRAINBACK w/check valve)
VeRical Lift=��ft
PUMP TANK: SEPTIC TANK(S):
Volume= �-C�� gal Total Volume= /d ��j gal
�
Manufacturer. �A✓,�i��r���/' Manufactrirer(s): �i'1.���`/��.p�t�'
Pump Manufacturer. 2�7v,//F?�'
Install approved effluent filter at the septic tank outlet
Pump Model: q� ��a�,��,mP��� immediately uastream of the pump tank inlet.
Controls/Alarm Manufacturer. ,S>� Rk�,.,,,A„4 Filter Manufacturer: ����- J�c/G P-
Controls/Aairm ModeL !c� / ,�1�i,,,.
Fiiter Model: F�D���
Float switches containinq mercury are prohibited.
PAGE40F4
In-ground Dosed-Gravity Management Plan
IMPORTANT:
The owner of this in-ground dosed-grevity system shall be responsible for its perpetual operation and maintenance
pursuant to requirements of SPS 382384,Wisc.Admin. Code. Pursuant to SPS 383.52 (2),Wisc. Admin. Code, this
system sha�l be considered a human health hazard if not maintained in accordance with this approved management
plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POVYTS Maintainer in
accordance with SPS 383.52 (3),Wisc. Admin. Code.
Maximum Disoersal Area Ooeratinq Limits:
Design Flow= �C�'C� gpd; BODs'— ZZa mgL''; TSS 5 750 mgl-'; FOG 5 30 mgL''
Inspection Checkiist INSPECT EVERY 3 YEARS
o type of use
c age of system
o nuisance fadors(i.e. odors, user complaints, etc.)
o mechanical malfunction (r.e., pumps, valves, switches, floats, etc.)
o material fatigue(i.e., leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i e., distribution/drop boxes)
o neglect or improper use(i.e., exceeding design capacities, prohibited activities, etc.)
o extent of ponding in distribution cell prior to dosing
o dosing irregularities-if app�ica6le (i.e., pump re-cycling, float switch settings, etc.)
o elec[rical components-if applicable(i.e.,wiring, connections, switches, controls, timers, alarms, etc.)
o distribution Iaterai 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 Seotic and dose tanklsl 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 liquid volume of the tank(s) or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code.
o Effluent filter(sl sha�l be inspected every 3 years and shall be Geaned when necessary to remove any
accumulated solids according to manufacturer'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: �l.�(�',(� ��YI �"� Phone: ������K�iJ
Local government unit: Phone: �6,�V/,����[�O
Local govemment unit address: IO(DlO lG����,Gl�,�,ZIP: � 'G O z �
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 3�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 that any failed treatment component of this PON/TS 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.
System Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33,Wisc.Admin. Code.
� w t'7:.AL I.HF'ALI i Y l.UtiVt . - - ,
s . " MODEI. "98" 4_ � 5�� �..i ' �
, _
� � ,
; ; ; :
; i
% •- i � � I � _�.,___._ _'__"_�_". _"" _ �'
�L�_ __ __"} 1 � ! r�-`�-' � �
� '— � � • c�r �_
� j : , - �
f � I , �r,� , �� � 3 5/e
,
� i � � I `f, f'� \ � '� i
� 6 -- . ___ ___ : t •, ' � ('D l � �.`.' '' ii , � ;
�r
'J V� � . � ` i ��---�
/1 � , � �
� . � . 1 1 Ll t \ C '� . i
z ; ` 't_Y`'� �
y .S 5- - — � -- � ^\ �r ��,\\� 4 3/t 5
� � --i� 4 � � I `�-,l��.r� l�j `� .�
o I � '�='�1
_ {so— .
� � j ; — ti
�
� � ; ,�z_, , ,�z v�r -
�—�-- �
� 5- —t— ---
f � ' �
; '
_ ° - i— � ; ; ; ' �esialf per manufacturers
:: s CALLaNS � ,o s� ,o .o sn fiQ , 70 ec qu�rements.
+---��
.:TcRS��� � "--- 1� — 240
o FLOW PERMlNUTE �- z
i ___.�`_ ' '�c', j -_�
i i k �F�1 ��'
; J�
r"--- -��
. �.��._- - �tr���"- ��
�` f i 1-�_.
' T07µ O'fMAL1G tSA�y{{,pW►qA Y�A{JiE ( ' �
E�f WENT MD DEW�TEA�y3 ; r�_--____� ,
� _"'_'__'__-' " � . �
1 } t ' ' \
cAPac+rr ! '� �
NEAD UM(TS,'NIN � ,r---i�;—.----�
� ; � i
FeET u�as uts ��as � ? �
i j � t
. 3 1.52 T2 213 �� � ? �r
IO .1.00 Ol y�f � i �—_�_ �1 4 ----_�
� 13 t.37 t5 17D ' � '' --• � �
; 20 4to � 2s ps i � ' --` _ �. 3 5/16
--j----, � �- ,� � ,�,n_�
lackV�fw 2�' ,1----`----_..._._ ��,' J'"'"`.�!::�_____--�-
CONSULT FACTORY FOR SPEClAL APPLlCAT10NS
• _�eancai aftemators, tor duplex systems, are evaffab;e and • Faercury tioat sw;tches e:e avai►abie tor controflfng single'and
supp;,ed with an afarm. ;r,;ee phase sys;e:rs •
• MechaNca! a".ernators, !or duptex sys;ems, are avaliabla wfth ot • Doubie piggyback r-ie�cuy lfcat sw;;ches are availabls ;or
wilhout aiarm swaches. varlable ievet lo�g cy�'e cCr;•o+s
SELEC7tON Gu�DE
__ _ __ Standard at1 models - Welght 39 tbs. ► ' t. tntegratRoatoperaled2pae Tecr,anicalswilch,noa�uernelcontrolrequcreC
-- - - /t H.P. 2. S�nq4s PIppYDack merc�ry f:oa: swi;ch w douEta pi4pybeek mertury. tloai
— 99 S�rles Control S�tsetian switeA. Reier eo PMOi77.
� Moc�� VoN�-Ph Mod�� Am a I Sim S�x i Du f�x 9. Mxhsnicai altermtor SO-0012 0� !0-00)5.
� � 1 �. See fM0)12,Icr corrxt mods.of Elecuica;A1:erna�or, "E•Pak".
�'93 . t IS 1 Au�o 9.0 I i o+ 1 6 7 --
__ '�?� '15 t Non � 9.4 2 or 2 3 6 } J oi� d S S. Mercury xnsor tbal srr,ic� �D-0225 used es s conuoi nctwa:w, speati
`J48 - •2�+ -� Auto + 4.5 7 0� 7 6 7 _ duplex(J)or (1) tipa; system
, _--�- -- ---- -- - 6. Four(�) Apts"J•Paic".lu�,;on�cx, f�r wattrGpht connec4on w wired•in s�m•
�9� : 230 1 No�~�{.5 2 a 2 3 6 . �or 4 d S � piax w dupbx operation, 10ti'�402.
) 'wo ;2) h::e"J-Pnk",!or we'e^igM con�ec!1on or sP(ice.
Fa r Wr,r.a;,.�:on aAd.tbrta;Zw�.s�o�xxu�N�r b uuUp on Co�nOLsalion S:+ru�. Cui:3 i�, CA U T i O N
An inaLNatypA pi wnGot�. pf�n pe�,ce� �nd ..�r�nq �Aould Da done by � qw�,�
v+,:;t5a:., ue•cuy S.+,t_r.es. FAt,an; E+c'riW Ah.,nua. FMWeE: 1.4envuu, A.•,erru�r, f»e ��e•n»a .i.cvui.r� ar .+.arw.1 •�.e ..a.y wa.• .n'ouw a ta�oww �ndw�
cA,4:aD5. A:ar�-. P�ckaqe �Ah'b�J S..�rp�`,x.`a�� Basint. FMOta);a�$;mp4t Gpn�td 50�� Inp Ne a.oal r�unt Mat;onal EMcVn Cx� fNEC) �nC I1M Oecupat.onat 5�1.q •.�a
��.ti'J7
H��n^ Aei (05.4�)
RESERVE POWERED DES{GN
For unusuai conditions a reserve safery factor is eng�.�eered into tha design ef every Zoeller puma.
MAiI 70:P.t? BOX 163d7
L" �� I I�� � La�sw!'e. KY a0150-DJ47 'fanulac�u�ers ol
p / SH1P 7D:328D 0�A!dtcrs(ane „ „
l• • itvr'S:�d7?. KYtG2!6 ,�UAl/TY/�U.t/F3' �NC£ ,�j7,9
' ''� r4o1, 17�.i??± • c,�trcR?�, »d.1;i!