HomeMy WebLinkAbout010-941-36-1405-SAN-2024-013 _ � Department of Safety c°°°`Y ��
- � = & Professional Services, �� ?
_ � Sanitary P it Number(to be filled in by(
�_ , Industry Services Division ��
_ (� S 1 �l I '� -c
. .. �
Sanitary Permit Application State Transaction[vumber �
In accordance with SPS 383_21(2),Wis.Adm.Codc,submission of this form to the appropriate governmental unit
is required prior to obtaining a sanitary permit.Note:Application forms for state-0wned POW7'S are submitted to Project Address(if different than mailing addre,$)
the Depariment of Safety and Professional Services.Personal informadon you provide may be used for secondary
puiposes in accorda�ce with the Privacy Law,s. 15.04(I)(m),Stats.
I.Application Informarion-Please Print All Information � '�'(�,
Property(hvner's Name Parcel#
� � �' •36�1 0�
Prop rty Ownet's Mailin Address Property Location
�°� � d e� 5 c,,,�-��" ��--
City, tate Zip Code Phone Number
' �_ � U ,1 �N�y+,SV✓iUL�y4, Section ��
, Ifi q
I .Ty of Building(check all that apply) Lot# T 't'� N R � E or
�tii
�1 or 2 Family Dwelling-Number of Bedrooms_ 2 Subdivision Name
✓ �-----.
Block#
❑Public/Commercial-Describe Use �-
❑City of
❑State Owned-Describe Use CSM Number ❑Village of
�g�� 3G I3Y3 §�-ro,�or
�
III.Type of POWTS Permit:(Check either"New"or"ReplacemenC'and other applicable on line A. Check one box on line B.Complete line C if
a licable.)
A' �,New System ❑ Replacement System g Y � P ) p �
❑ Other Modification to Existm S stem ex lain Additional PretreaUnent Unit(ex lain
B' ❑ Holding Tank �,In-Gmund ❑ At-Grade ❑ Mound ❑ Individual Site Design ❑ Other Type(explain)
(conventional)
C. ❑ Renewal Before List Previous Permit Number and Date Lssued
❑ Revision Chartge of Plumber ❑ Transfer to New Owner (�
Expiration ' ��^ �" ` � 7/�( �� �
IV.DispersaU'I'reatment Area and Tank Informallon:
Design Flow(gpd) Design Soil,4pplication Rate(gpd,'s� Disper.sal Area Required(s� Dis ersal Area Proposed(s� System Elevation�
�_� �. �� � �.� � � � Z ,�
Capacity in Total #of Manufacturer Y
"I'ank Information Gallons Gallons Units p � U � n '`-'
� � V Vi
New'Tanks Existing7'anks � o °.3 � a°'i .°'nN � �
a. U �n v, v� t�. C7 0,
Septic or Holding Tank � � �� � 3� � �� � � �
Dosing Chamber ,�
V.Responsibility Statement- 1,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name(Print) Plumber's Signature MP/MPRS Number Business Phone Number
- � S3 � � �15-5��- lh ��
Plumber's A dress( treet,City,State,Zip Code) �� � � �
��J ��� N w � i.0� � a'
VI.C unty/Department Use Only
� Peimit Fee Date Issued Issuing Agent Signature
�p v O Disapproved
�� ❑Owner Given Reason for Denial $�`� � � �' �� �������C��
Conditions %a eason�o�Disapproval '
I ' ' 'r��,�-. '`-�`��'r,--Z 1
, �
, , � I ,� �
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:. , � �� �� 3� �a� s , ;:� �, ,
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_ _ .__- _ _ _�_�._�_.��,.�Y�w.��.. �; ;
ayi� . ��' JAN 31 ZQ2'. __^
Cs� �3- � ig _�k�_ - ------
a-�� �.:�>��,-Er� c;,:, :,,,;
Attach to complete plans for the system and submit to the County only oo paper not less thao 8 ti2 x I1 inc e
�
� �.y�SD �T ��`��"3 NO R�Fl1NDSAFTER
SBD-6398(R.03/22) ISSUE OF F'fRM1T
� PAGE 1 OF 5
In-Ground Dosed-Gravity Plan
Index & Cover Sheet
Component Manual Design References:
In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
Pg 1 of 5 Index & Cover Sheet
Pg 2 of 5 Plot Plan
Pg 3 of 5 Dispersal Area Cross-Section & Plan View
Pg 4 of 5 Pump Tank Specifications
Pg 5 of 5 Management Plan
Attachments: Enclosures:
Pump Curve POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description
Owner Name(s): ��,� i���'� 5 f�,l E-�- �_x t�,v✓�. Phone: - -
Owner Address: � �- � �� �,����� �v� �� 5 ,i� ���f,✓�t'1�ZiP: ���a-�
Project Address: �.%}�o lV �� bwu �- r�� i.� ,�� � � �$�'�
Govt. Lot: _1/4 of 1/4, Section�_, T �' � N-R�E ❑or W�
Township: �-��; ���,( County: l-,�,,�t,�y��
Project Parcel ID #: �J � � � � 3 E � `���J
Designer Information
Designer Name: � .. ���"��n,� Phone: ��� -�- ��
DesignerAddress: 1��}L�V �o+,,,v� �-1�c��s�r►�,� '�� k Ra Z�P� ����-�
E-mail: . .� ;��,
License Number: � a � � � �
Remarks:
i nature: � Date: I�" 3 j - Z�
S � Original signature required on each submitted copy.
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�py
IN-GR�UND DOSED-GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down-sizing credit}
_ ,
•-min.17.'� TYPICAL TRENCH
(ydcal)
SOIL COVER CROSS SECTION VIEW
"" (No Scale)
min.trcnch
deplh •
(�YPical) '. o '
_. _.. _.. , . ._._ ,. •.. . .a'Q',a
�_"'_ �q" . Q .
(typicap �, . � • Provide minimum 3 ft
, a
• " separation between trenches.
System Elevation =�._ ft
(typical)
Quick4 Standard-W
wl End Cap obsorvacion�ipe
— (rypicaQ (Show locafiion of inlet/outlet pipe connection on plan view.) �nstall por rt�an�fpcWror's TYPICAL TRENCH
�nstrucuons. PL/-�IV V�E�IU
_ _ ` (Na Scale)
��a��riwv�i�r�r►y��aa��.�ret:R, — -�'�- ` � — — `_ � � �� � +r��aaM���-x��wrr��rrri�M� q= 3.0 ft
� i ' ���I � { (tyPic�l)
arrk kilAkkltkl�elYrtYY�Y — — , ���'��7M�4Mi�a+�l���rr#�I�I
�� ._.* - - ..._ „ « �. _ _ _. _ r. _.._ „ — —
� �� �� �
�- ----- B = �� ft � --.-I 7'
�
(typicai) Quick4 5tanderd-W Chamber (T1
(�YPi�,��l) W
INSTALL PER TRENCH: (rn(d by Infiltrc�tor Systoms,i��.>
Install pursuant to manufaclurer's Inslruclbns. �
� L QuickA Std-W @ 20 ft' EISA/chamber= yi2o ft` �
CJ1
+ �,.. Pairs of end caps @ 6 ft2 EISA/pair= _�,�,._, ftZ
= Proposed EISA per trench= ,� ft' Required Infiltratian Area= lzso ft` Distribution Method:
x � trenches = Proposed Total EISA= ��ft' �d�,r.�
I ,
.. �SET �
PAGE50F6
SEPTIC / PUMP TANK SPECIFICATIONS
(No Scale) � •
4'0 Vent Pipe
>1011 Uam
BuilCing Ekc6i(zl muat mmply with
7T Min.w 2.011 ebwe SPS 316 eM NEC 300
EWDIMeC Flood Ebvafion W��a�� E�Qentl menhds neer m necessary.
���) A��� Junction Bo�
Vent C�p �CP��LoUcirp Menhole
IMPORTANT: m wem��p�ami uud,eo
Anchor tank(s)as necessary (rypn�)
3( )(9J cww�n
pursuant to SPS 383.4 8 a•M��.w2.o n eeo�
EsLbliahed Flood Ebvatiw+
MwmO
� /—n�rognt saei '
FinicMd Grade
duidc Diaoonnerl
78'Min.
CAPACITIES @ �5 gaUn � ,y.: ���'�
- • 4 �
Depth(in) Volume(gal)
/ n —*
A � L� Q OC� � � WeeP ApprowdJanbwiN
Hde Apprwed Pipe 3 R onb
B 2.� S CJ A Solitl 6rouritl
. I (bP��)
ICiI ( ,U /S C� � �
1L w�
D G.c� �s C -aI--�- ���_o�
��c] PUMP-0FF
*Pump Tank Liquid Level= ?� in � ��" �—a' ELEVATION= ����•`j ft
Force Main Diameter= „�" in ° �e INSIDE BOTTOM
� B'°'* ELEVATION= 'C.� ft
Force Main Length= I�ft 3'Approuad Beddinp Metenal BeneaN Tank
Vertical Head= �L ft
Force Main Void Volume= I`Z��� gal
+Min.Supply Head= 2 S ft
[C]Total Dose Volume DV = /5(, gaUdase
�� +FM Friction Loss= �•�% ft
(5X total lateral vad wWme<TDV 50.2X design flow) �
+(fo,ce main arainbedc vaume) +Fitting Loss'= CG ft
�(min.supply head x 0.3)�
MIN.PUMP DISCHARGE RATE= ZS gPm =TOTAL DYNAMIC HEAD= �`� 5 ft
�
PUMP TANK: SEPTIC TANK(S):
Volume= `15�' gal Total Volume= �5 c`_.- gal
��� ��
Manufacturer. ��'�5E=� Manufacturer(s): ��'�C=��r
Pump Manufacturer: z�� !I F r
Install approved effluent filter at the seotic tank outlet
Pump Model: �S � (SMatlrhed WmP a^'e) immediatelv uostream of the oum�tank inlet.
Controls/AlarmManufacturer. S � S FilterManufacturer. �,•D - "�'i�
Controls/Alartn Modei: i�/ H��'� Filter Model: `?�c')�i �2
Float switches containina mercury are orohibited.
�
�
� W PUMP PERFORMANCE CURVE
� w
MODEL 15111521153
so
� i
1�- 45 153
12 40
35
� �� 152
_
U �
L
Q
0 8 25 151
J
H
� g 2G
15
a
�o
z
5
� � � �
10 20 30 40 SD 60 70 86 90 100
GALLONS
LITERS 0 40 90 120 160 200 240 280 320 360
FLOW PER AfINUTE
WLP1585/950
--- -,s•-3��� -- --- - TANK SP�CIFICATIONS a a
� �� � �
—�� DIMENSIONS: rc o
WALL: 3' a a
�-------------�i iY----------� BOTTOM: 5'
i i i i Y COVER: 6' „
i 4" CAST-n-SEAL i i'i i4" CAST-A-SEAL j MANHOLE: 24' I.D. PRECAST CONCRETE RISFR o
i i i i i i HEIGHT: 58' --
i � i�i.i i LENG7H: 15'-3 3/B" > ..
��-�� m�yQ� ��-�� � �� ��-�� NADhi: B'-5 3/8� ir'
';m � � i �i�_ i ,y BELOW INLET: �S' .
� � � i�- �� `4 L1WID LEVEL• 38' � �-
m � ` �� � WEIGHT: BOTTOM 15,977 IBS. o �
� i ` � �i i i I � �� i COVFR 9�300 185. 's ; � N
� Fli.iER OR I I i I v I '� o w
� AAFF�F iiii - j � INLET AND OUTIET: � m o a
i i i i i � i 4' CAST-A-SEAL B00T OR EWAL GASKET w ;
� ilii J � �� �
�r -----�� �}----------<� INLET AND OUTLET BAFFLE AND FlLTER: v"i � o �
- - WISCONSIN, SEE DETAIL /10 4� o
(OTHER STATES SEE CHAR1) �„� �
TOP NEW UWID CAPACITY: 41.67 GAL/IN (SEPTIC) � �
25.00 GAL/IN (PUMP) �' x �
�
LOADING DES�GN: 8'-0' UNSATURATED SOIL O i �
� w I
o �
o TANK CAN BE USED AS: � N
� SEPTIC/SEPTIC, SEP11C/PUMP, � o '''�
Q� OR SEPTIC/SIPHON W � o
� -4" VENT
� COVER: MIX DESIGN /8 (NO FlBER) � °�
I _ ;o TANK: MI% DESIGN /9 (SMALL FlBER) `� �
� �
---�^. . . . . ---- . . . --- �_ CUSTOMIZED TANKS: � 3
INLET - � ---- -- �� ---- FOR CUSTOM TANKS CONTACT NAESER CONCRETE
OUTLET
� 1 _— _ _ . _ _ � 1�I�._—. . - �
„�j Q � 1. I _ K � �V1
jp U `n � � m J I � Q
� a a` 1 � m ���� n � l a� M o Q
� c n a � � �
.� �3,� i�'i �a 1 � v a � Z
I .I � Q
'�-___-________ ___ __�__-1 L�________,_i � �
� -�----�--- RENEWED BY '� v
� REVIEW DATE � a
�
DRAWINGS SUBMITTED
SIDE VIEW FOR APPROVAL
APPROVED BY: S41EET NO.
APPROVAL DATE: � �
oF
PRODUCTS NEEDED BV: _ / �
TANKS ARE MANUFACNRED TO MEET OR EXCEm AST?A C-1227 REWIREMENTS -�---- ----�
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 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. Furthertnore, all inspection and maintenance activities shall be performed by a registered POVYTS Maintainer in
accordance with SPS 383.52 (3),Wisc.Admin. Code.
Maximum Dispersal Area Operatinq Limits:
Design Flow= Z,�`(3 gpd; BODs'- ZZa mgL''; TSS_< 150 mgL''; FOG <_ 30 mgL-'
Insoection Checklist INSPECT EVERY 3 YEARS
c 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.)
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 exterrt of panding in distribution cell prior to dosing
o dosing irregularities-if applicable(i.e., pump re-cycling,float switch settings, etc.)
o electncal compone�ts-if applicable(i.e., wiring, connections, switches, controls, timers, alarms, etc.)
c 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 Check�ist 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 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 maintenance reports shall be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc.Admin. Code. Report any component failu�e or malfunction to:
Name of individual or company: /�e� S �✓�i�� ��.r -c_ Phone' 7/�� r/`�i���G/�Z
Local government uniY. _� V � Phone:�/� �ji � —L/ y-/��
/ '---�
Local government unit address�p�/ �.,-.e..'L� y�• /�«,.��u�GGiL ZIP: � �/ �t�i S
Any defec[ive part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1),Wisc. Admin.
Code. Repair or replacement of faiied or malfunctioning components shall comply with SPS 383,Wisc.Admin. Code.
No product for chemical or physiral restoration of the POWTS may be used unless approved by the department in
accordance with SPS 384,Wisc.Admin. Code.
Continaencv Plan
In the event that any fafled treatment component of this POWfS 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
If use of this POWTS is discontinued, It shall be abandoned in accordance with SPS 383.33,Wisc.Admin. Code.