HomeMy WebLinkAbout010-182-00-0900-SAN-2024-027 � `,.� -
���-,;;-. � c/�
--�� Industry Services Division � Counry
'" 4522 Madison Yards Way jfi(,�,' �� -�
;;;�,a - �
'-' =P ' Madison,WT 53705 Sanitary Permit N�filled in by C
1>;� �;`�j` P.O.Box 7302 / � �
\'���,wi'� Madison,WI 53707 �p �� � ��
��t)f(1��:j �
Sanitary Permit Application State Transaction Number �
In accordance with SPS 3R3.21(2),Wis.Adm.Code,submission of[his fortn to the appropriate go��emmental unit J
is rcquircd prior to obtaining a sanitary permit.Notc:.Application forms for statc-owncd POWTS are submittcd to Project Address(if difterent than rnailine adclress)
the Department of Safety and Profession�j Services.Personal information you provide may be used for secondary
purposes in accordance with[he Privacy Law,s. I5.04(1)(m),Stats. n�C
I.Application Information-Please Print All information ��.�L �;��,(�C►U� �
Property Owncr's Namc ��\���j • „� �$ parccl�
C����r �2 s � - �i v►� s c���� �I �����f dI C) -�l <h Z - �ia •-o�b L�
Property Ow�ner's Mailing Address Property Location
� c s 3 ''�- 5-f-- 1�1� G
City,State � Zip Code Phonc Number
�j'� L�� � �N 7 W(.��� __��__�i�, � /I� Section ��
Ii.Type of Building(check all that apply) Lo��+ T N R d E o W^'
�1 or2 Family Dwelling-NumberofBedrooms � � Subdivision Name
Block# ��, w��) �L
�ublic{Commercial-DescribeUse .—
�Ciry of
❑State Owmed-Describe Use CSM Number illage of
-- �Town of TTr�_i.t W�Y��
III.Type of POWTS Permit:(Check either"New"or°°RepiacemenY'and other applicable on line A. Check one box on line B.Complete line C if
a licable.
A �New Sys[em nReplacement System ❑Other Modifica[ion[o Existina System(explain) �Additional Pretreatment Unit(explain)
L_1
B' �i-Tolding Tank �In-Ground w rJM(� �t-Grade �Mound individual Site Design Other Type(explain)
(conventionai'� b
C• ❑Renewal Before �Revision ❑Change of Plumber ❑7'ransfer to New Owner ist Previous Permit Number and Date Lssued
Expiration `��
IV.DispersallTreatment Area and Tank Information:
Desi�n Flow(apd) Design Soil Application Ra[e(gpd/s� Dispersai Area Required(s� Uispersal Area Proposed(s� System E(evation
�Q ,� "_15tU �`—[ q ' �'1'�o,�lS`
Capaciry in Total #of Manafacturcr
Tank Tnformation Gallons Galions Units � � o '� u
Ncw Tank.a Existing Tanks � e � � � � � �
0
a U in y rn 'u. C7 4
epti or Holding Tank O�J �_� �� � �S
os g Chambcr / � � � �
lD
V.RespOnsibility Statement-I,the undersigned,assume responsibility for installaHon of the POWTS shown on the attached plans.
Plumber's Name(Print) Plumber's Si�arure MP/MPRS Number Business Phone Number
(� s� �,�lt�z � �srerz� ��s -s�� --s��ay
Plumber's Address(Street,City,State.Zip Code)
� D� �O �U CJ'M� L�(_,c��� K-G' S T�'►1{ �.,C�F-� W � S Lf$� �.,
VI. n lDepariment Use Only
� p ov d ❑Disapproved Permit Fee Date Issued Issuing Agen[Signature
❑Owner Givcn Rcason forDct�ial � l�,oo ���� ��y � -�, /���J����j._j_�,�L��'
" J � l
Conditions of Ap roval�Reasons for Disapproval
� � A o �
� � I �F�;�-�,�
_ �F__�.��--�_� �� �
��,�,F� i�i o ..--� FEB 2 6 2024
CC S� �� -�l�� s s5 sAw�r�A couN�-,r
ZpNiNG ADMtNIS"fRAT10K
Attach to complete plans for the system and submit to the Counh•only on paper not less than 8 1/2 x i l inches in size
SBD-6398(R.02/22) NO R�Ft1NDS AFTER
ISSUE OF PERMIT
�Ci3�
PAGE� OF 6
In-Ground Dosed-Gravity Plan
Index & Cover Sheet
Component Manua/Design References:
In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
Pg 1 of (a Index&Cover Sheet
Pg 2 of �v Plot Plan
Pg 3 Of � Dispersal Area Cross-Section &Plan View
Pg 4 of � Pump Tan S ecifications
g !n pon,p-r'u.,e�r. �K-�
Pg 6of b Management�lan
Attachments: Enclosures:
Pump Curve POWTS Application for Review
Soil Evaluation Report&Site Map
Project Name/Description
OwnerName(s): C�Qr1e s Q. �o�Ps�� Phone: - -
OwnerAddress: IS�S" 3'� s� i.iG s{Qploc M � Zip: 564"74
ProjectAddress: o.. �G. �e�wno,-1 PI4 �, l-�-��-,�-�1ca
Govt.Lot: 1/4 of _1/4,Section O f__,T �-fb N-R�E❑or W�
Township: �c-U�.�-� County: S4ti�ti e�-
ProjectParcellD#: DIO— �SZ- 00 — 09p0
Designer Information
Designer Name: [��- - Sc�. J��z Phone: 7l5� -�- 5 T��
DesignerAddress: 107(�w S-���i�u� � S-�a..� l-a� Zip: S�fl,`7b
E-mail:
License Number: /5!6/�
Remarks:
. �� . 2 -Zy-Z
Signature. Date. y
�aI signature required on each submitted copy.
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IN-GROUND GRAVITY DISPERSAL AREA � SepticTank(s)Manulacturer:
l,l�i s��--
Stepped Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down-sizing credit) SepticTank(s)Volume(s):
��d�� gal gal gal gal
7 � � � Effluent Fflter Manufacturer:
� [C� M �
SOIL COVER ��
—min.12" � � �
(typlcaq Effluent Filter Ma1el/t:
t z„
min,lrench
TYPICAL TRENCH �i�P�n -
CROSS SECTION VIEW (ryP'C�I) a
, ___- - _ --
• ' ' ° Provide minimum 3 ft
4 °:
(NO SC�IE� � �iypc�ai�` -�.; ° • separation between trenches.
4 a
-. . e
a
Highest Trench Lowest Trench(as applicable)
System Elevations= ��S•�� tt; ��•�s ft; ��,� ft; ft; ft
Quick4 Standard-W
wl End cap ObservatlonPlpe TYPICAL TRENCH
(Show location of inlet/outlet pipe connection on plan view.) (lyplcal)
(typir,al) PLAN VIEW
Install per manufar.Wrer's
' Instructlons.
(No Scale)
�� - - -� - - _- - - - �j� - - - - - - - ��- - `�'',�—�� ' ��
� � � �� i �:,� .�. ( ` ,, � ��r �� �A= 3A ft
. � � ,.: ! ' ` `�F, ,��
-'—� -- ; ` (typical) �
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5`�k tt —=I �
f--- -- B = m
(typical) Quick4 Standard-W Chamber u'
INSTALL PER TRENCH: (typica�) �
_ (mfd by Infiltrator Syslems,Inc.) �
Install pursuant lo manufacturers instructions.
� Quick4 Std-W @ 20 ft�EISA/chamber= Z b� ft2 �
+ � Pairs of end caps @ 6 ft2 EISA/pair= �Q ft2
= Proposed EISA per trench= ��� ft2 Required Infiltration Area= ��� ft` Distribution Method:
x -� trenches = Proposed Total EISA = ��� ft2 �?r4�� �� __
' PAGE40Fb
GRAVITY-DOSED
SEPTIC / PUMP TANK SPECIFICATIONS
(No Scale)
4"8 Vent Pipe
>10 ft imm
Building ElecMcal must comply lh
12"Min.or 2.0 ft above SPS 376 and NEC 300
Esta6lishetl F!ood Elevation W¢atherpmo' .EMend manhole nser as necessary.
�ryP���� Junction Box
- Approved qpp��ed Locking Manhole
� IMPORTANT: Vent Cap �itn waming Labei Attached
Anchor tank(s)as necessary ` (ryP�����
�Conduit
pursuan[to SPS 383.43(8)(g) a^M��r,.or z.o n abo�e
Establlshed Flood Elevation
(rypicaq
�Alrtight Seal'
Finished Grade 1
=- �uick Discannert i
�
18"Mln.
CAPACITIES @ '.4 z gal/in , cryv��i>
Depth(in) Volume(gaI) —1
A `��'F'�I J��.�� -* � Weep .�APProved Joints with
B �O ,�� `� Hole Appmved Pipe 3 ft onto
r q Salitl Ground
�C� ���Z ��'��s�f � (�vP��q
LAlartn
D e } I�—o�
I 2 I i 3y ��� PumP PUMP-OFF
'rPump Tank Liquid Level= �3 in 0—� ELEVATION= �� ft
�� �
Force Main Diameter=� ��in i co���e�e INSIDE BOTTOM �/
B�°°k ELEVATION= C ft
��
Force Main Length= 3b' ft 3"Approved eedding Material Beneath Tank
3�, x .�l 3�= 4.Y�7 + 90
Force Main Void Volume= L�� ��� gal
[C]Total Dose Volume TDV = j gal/dose
�
(<02X design Flow+force main void volume)
Vertical Lift= �� � ft
PUMP TANK: SEPTIC TANK(S):
Volume= L��gal Total Volume= l 0 D(� gal
Manufacturer: �eiS�Zv-- Manufacturer(s): l,(
Pump Manufacturer: ����^�/
Install approved effluent filter at the septic tank outlet
Pump Model: ZS�� �$Qed«a�eaP mP �,e� immediately uostream ofthe pum�tank inlet.
Controls/Alarm Manufacturer: S�C Filter Manufacturer: ���y�����
Controls/Alarm ModeL• �-
Filter Model: � Z�
Float switches containing mercury are orohibited.
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/ DRAWN BY: SME SCALE: 1 4"=1'-0" PRE-POUR:
m WIESEa COIICAETE RE�.
� � SEPTIC MANUAL oa�: dnnunar zon onre. aosr-aova:
WDt6 US HWY 10 MAI�EN ROCK, WI 54750
Z
� REVISED JAN. 2011 800-325-8456 Fi�E: m000/soo-ua
PAGE b OF (O
in-�ro:;r�� Gravity Managem�nt Plar�
IMPORTAN?:
The owner cf:his in-grour,d gravity system shail oe responsible fcr its perpetuai oper2tion ar.d mainTenar.ce pursua^i to
requiremerts cr SPS ?82-384,Wisc. Admir. Code. Pursuan:to SPS 383.52 ;2;,'VJisc. Admir,. Code, this system sf all
be considered a numa� nealtn cazard if not maintained in zccordance with this appreved managemert olan.
Furtnermore, 2il inseec?ion ard mainterance aciiv�ties shal! be pe�crmed 'oy a registered POWTS Maintainer in
acccrdarce with SPS 383.52 (3),Wisc. Admir. Code.
Maximum Dispersal Area Operetinp Limits:
Design Flow = 45d gpd; BODs�Z20 mgL''; TSS <_ 150 mgL''; FOG _< 30 mgL"'
Inspection Checklist INSPECT EVERY 3 YEARS
o type ot use
„ age of sysiem �
o nuisanca factors (i.e. odcrs, user complaints, etc.)
c mec'^.anical nali�mcten �i.e., pumps, valves, switcnes, floats: etc.)
c materiai ratigue (i.e., leaks, brezks, corrosicn, e!c.;
o soiids volume ir anaerobic treatmeni tar,k(s) and any distribution appur!enance(s) (i.e., distnbutior�l drop boxss)
o neg!ect cr improper use �i.e., exceeding design capacities, prohibited zc?NiSes, etc.)
o extent cf ponding in dis,nbuticn cei! pnor to dosing
c dosirg irreaularities-ir zppiicable (r.e.. pump re-cyclirg,float switch settings: etc.)
o elecVic21 compenents-i`: zpplicable (i.e., wiring, cornections, switches, controls, timers, alarms, efc.)
o distribution iateral or iateral orfice piuggir.g (measure laterai distal pressure-compare to desigr specificatio�)
o surface discnarge c?efiiuert or sewage back-up intc structure served
Maintenance Checklist MAitvTAIN EVERY 3 YEARS (or when necessary)
., Septic and dose tank(s)s!�zli he pumped by a certified septage servicirg operator licensed under s. 28?.48 Wis.
Stats. when the volume of solids in the tank(s}exceeds onrYhird ('l/3)the liquid volume of the tank(s) or
zs reGuired by ioca! ordir.ar.ce. D:sposa! o`con:e.^.ts shail be pursuari te NR ?13, Wisc. Admir. Code.
c Effluent filter(sl snal! be inspecec every 3 years and shal; be Gezned when necessary to remove any
accumul2:ed solids accerding tc maru;actwer's soecifications. A servicir,g penod will always be greater than 12
mcr.ths.
System maintenance reports shali 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 ccmpany: C�Q��e 5 R„• + !no�+i.Psm n Phcne:
Loczlgcvemmentuni!: S�WH-e�- �-'U zovt�vi. 0 ?hone: Z �s- 6'��E�gZ��
Localgovemme.^? u.^.itaddress: 1 �6�'� P�4�h SY �y� �4-Nw4r� I.e�� ZIP: S�{ �5�3
Any defeciive part of this system shail be repaired, replaced, or removed pursuant to S?S 383.51 (1),Wisc. Admin.
Code. Repar or repiacement o!�2iled or mzifunctioning components shal; ccmp!y witn SPS 383,Wisc. Admin. Code
No product for cnemical or p'r:ysical restora?ion of the POWTS m2y be used unless approved 'oy ihe depzrtmert in
accordance with SPS 384, Wisc.Admin. Code.
Continqencv Plan
In tne ev=nt that any*ailed trestTent componert oi this PONJTS cannet be repairec, it shai! be r2placed pursuani to
z plar. subm:Yed to t^e appropriaie ager:cy ror review and approvaL A`ailed in-ground dispersal compor.en: may be
abandon2d ar.d replaced by a code-complyiag dispers2l comooneri ir z ore-de:er�^:ired are2 oi suitable soils.
SYstem Abandonment
If use of this POWTS is discor.iinued, it shaii be abandoned in accordarce with SPS 383.33, Wisc. Admin. Code.
Liberty Pumps 280 PUMP 280 - 1�2 HP Cast Iron Submersible Sump(Effiuent Pump Non-Automatic 10(2b/22, 7:41 AM
`•av? iJ�,�:�i�. �:ii'.fi�7� �3�C:f1;G�� �i'8(: ��1l�?�3tfit� Ofl �Lif71�S & 1=1CC@.�,SdC!P.� �ree SelijJ�:�33(„j. Uii �t<ii;fa3 L�
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Cancel
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Media Gailery X
Liberty Pumps 280 - 1l2 HP Cast Iron Submersibie Sump/Effluent Pump (Non-
Automatic)
Performance Curve: 280-Series
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