HomeMy WebLinkAbout002-940-18-3301-SAN-2024-103 '� ' � Industry Serviccs Uivision Counry � � �
� 4822 Madison Yards Way �
_ ,�j - Madison. W'l�3705 Sanitary Permit Num r(to be filled in b� C
PS P.O.Box 7302 �,p 9.�
�;c��,_.
Madison,WI 5302 �y S I � 5�% S
r
Sanitary Permit Application State Transaction Number p
In accordance with SPS 383.21(2),Wis.Adm.Code,submission ofthis fonn to the appropriate governmcntal unit '—� �
is required prior to obtaining a sanitary permit Note:npplication forms for state-o�vned POWTS are submitted to Project Address(if different than mailinb;iddres,)
the Department of Safet}'and Profcssional Services. Personal infomiation}�ou provide may�be used fur secondan� � ��� � ���
purposes in accordance���ith the Privacy I.a�c.s. 15.04(I)(m).Stats.
I.Application Information-Please Print All Information
Prop�Owncr's�me ,�� �r��� -����� � � � ����
Propert�Owners Mailing Address Property Location
°�� ��� � �7 w �/�
C�, tate Zip Co�dJe Phone Number (� �(�
�� J� V�� �I������ V �� � �� i�n,V� ��a. SCCT1011 ��
IL Type Building(check all that apply) � Lot# T N R V�_E or W
�1 or 2 Family Dwelling-Number ofBedrooms
�' Sub ivision Name
Block# '—�
❑Public/Commercial-Describe Use ^
❑City of
❑State O��ned-Describe Use CSM Number ❑Village of _
�Town of ��...` L.2. --
lll.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' NeN S stem
� y ❑ Replacement S��stem ❑ Other Moditication to E�istine S}'stem(explain) ❑ Additional Pretreatment Unit(explain)
B.
❑ Holding Tank In-Ground ❑ At-Grade ❑ Mound ❑ Individual Site Design ❑ Other'Iype Iexplain)
(conventional)
C• ❑ Rene�cal Before ❑ Revision ❑ Change of Plumber List Previous Permit Number and Date Issued
❑ Transfer tu Ne��°O«�ner
Expiration �
IV. Dispersal/Treatment Area and Tank Information:
D�n Flow(gpd) Uesign Soil Ap�plication Rate(gpd/sfl Dispersa �e Required(st) Dispersal Area Propose�� Systep�Elevation �
5b 7 � � �q "ly , S
Capacity in Total #of Manufacturer
��
Tank Information Gallons Gallons Units � L o 'v u
Ne�v Tanks Existing Tanks � c c�.� ` � L � �
c
n, C� i� � v� w :7 G.
Septic or Holding Tank �� 1 b d� w����
l
Dosing Chamber
V.Responsibility Statement- 1,the undersigned,assume responsibilih�for'nstallation of the POV1''1'S shown on the attached plans.
Plumber�s Name(Print) , � Plumb s i ature MP/MPRS Numb r [3usiness Phone Number
(�iA S� M��911� v, SD C o��C3 .).�� 7� �� -6 �
Plumbers Address(Street,C>ity,Sta[c.Zi ode)
��h ��-�'�� ��`l.�- � � �� !�-� `.'- J � ���
VI.Co ty/Department se Only
� S Permit Fez Date Issued Issuing Agent Si�nature
Ap r �e ❑Disapprovcd �
❑Owner Given Reason for Denial � � (�•� S � � �a��l �l'�,tz�t�,�{t-�?AivL.f.�
Conditions of ApprovaUReasons for Disapproval � �,,, �je
� � � , �=_ �--�� ,�; �.
,. J ��� � j , �
W �i� � ��r�� �ate 5�����.y � �. � �� ; x
�
G
�-- �hk# 5�y� �AY � 8 2024 �--:
cs� � �- o�c�� ,
i�Cl"}:��g �..�.__.._._.� �AWYER COUN i'i
tNG ADMiNISTRA�ION
Attach to complete plans for the s,ystem and submit to the Cuan[y only on paper not Iess than 8 I/2 x 1)inches in size
Mc,�i'1 NO REFUND6 AFTER
sB�-639g(x.o2i2?� ISSUE OF PERMIT
� �`�:�
PAGE 1 OF 4
In-Ground Gravity Plan
Index & Cover Sheet
Component Manua/Design References:
In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
Pg 1 of 4 Index & Cover Sheet
Pg 2 of 4 Plot Plan
Pg 3 of 4 Dispersal Area Cross-Section & Plan View
Pg 4 of 4 Management Plan
Attachments: Enclosures:
POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description
Owner Name(s)� `—'`V'�"�- Phone� ( � _SsU _ ���
Owner Address. �� 'N / a,7 �ll; Z�p; 54848
Project Address: �� b �
Govt. Lot: S� 1/4 of s W 1/4, Section � � , T �b N-R �`� E❑or W �
Township: �� �--�- County: ��'� `-v
Project Parcel ID #: �O�' �V►4'- �� " �3��
Designer Information
Desi ner Name: ' `������ V i 5�� Phone:��5 -�� - ��' � 1
9
Designer Address: Zip: J��$�
E-mail: v 1 So���� � � Co�r� ... r � . ���� ��t ,t � r.a�:��,
License Number: ����� �
Remarks:
Signature: l Date: `s � '�
Original signature required each submitted copy.
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IN-GROUND GRAVITY DISPERSAL AREA SepticTank(s)Manufacturec
,N,es�r—
Uniform Elevation Trenches with Quick4 Standard-W Chambers SeP�;�Ta�k�s���,�me,s,.
3-ft Trench (down-sizing credit) �,o�a
gal gal gal gal
Effluent Filter Manufaclure[
(
� L .��
Effluent Fil[er Model#:
a i2
SOIL COVER (Npicap
,2�,
min trencn
aepth
c+�P�=a�� • TYPICAL TRENCH
-- a CROSS SECTION VIEW
F---aa..
��vp��a�> (No Scale)
����. . ,��C Provide minimum 3 fl
Sys tem E leva tion=� 'J ft s e p a r a t i o n b e t w e e n t r e n c h e s.
(rypical)
Quick4 Standard-W
w/End cap 06serva�lon Plpe TYPICAL TRENCH
(typical) (Show location of inlet/outlet pipe connedion on plan view.) (n�vicap
Installpermanufaclurefs PLAN VIEW
inshuctions.
(No Scale)
r ------ —��-------��--------- —, 1
. . � . ., �. - �.. - :;. � A=3.Oft
L-------�— (N[�i��p �
---��-------��---- -----� D
r B- n —=i m
(rypical) Quick4 Standard-W Chamber W
INSTALL PER TRENCH: (typical) �
(mfd by Infiltrator Systems,Inc.) �
\� . �"� Install pursuant to manufacturefs ins[ructions. �
Quick4 Std-W @ 20 fl�EISA/chamber= ✓ ft�
+ �Pairs of end caps @ 6 ft'EISA/pair= � ft� � 6�
=Proposed EISA per trench= ft� 3 Y� Required Infiltration Area=� ft` Distribution Method:
x � trenches=Proposed Total EISA= � tt� �zt��J�"'�') "'�"�`^7'1
� �� v
� bga .
WLP � 000
TANK SPECIFICATIONS � o
8'-8" a a
DIMENSIONS:
w rn
WALL: 2 1/2" � o
� �
4" CAST-A-SEAL 4" CAST-A-SEAL BOTTOM: 3"
COVER: 5"
w
___- MANHOLE: 24" I.D. PRECAST CONCRETE RISER Q
���'� ��\� HEIGHT: 53 1/4" �
�� �� LENGTH: 8'-8"
ii �� >
�� ��' WIDTH: 7'-2" �
ii , �'L�` �� BELOW INLET: 42"
� '� � �yP r�r����� LIQUID LEVEL: 36" o
`V � WEIGHT: BOTTOM 6,790 LBS. �
� � � " o
i� � � i� � COVER 3,195 u cai �
1 � � � � � ll 3 0 0
`�� ` ii� INLET AND OUTLET: � } � o
�� FILTER OR // � °' o �-
�� �, 4" CAST-A-SEAL BOOT OR EQUAL GASKET z 3
�� BAFFLE �, � 3 w
�� �i a a � �:i
��;� ,�%' INLET AND OUTLET BAFFLE AND FILTER: " � Q J
_ �n o o �
-------�� WISCONSIN SEE DETAIL #10
(OTHER STATES SEE CHART) �� o
�
� �
�
TOP VIEW LIQUID CAPACITY: 27.83 GAL/IN � 3
HOLDING TANK: � � �
OUTLET HOLE PLUGGED Q � �
ACTUAL CAPACITY: 1,085 GALLONS � o �
�
o LOADING DESIGN: 8'-0" UNSATURATED SOIL � � �
w `� I
v, � TANK CAN BE USED AS: W r o
Q � SEPTIC / HOLDING / PUMP OR SIPHON � S �
w W
� COVER: MIX DESIGN #8 (NO FIBER) � �
� ____ TANK: MIX DESIGN #10 (STRUCTURAL FIBER) � �
—— � �
---- ---- CUSTOMIZED TANKS:
WLET f_ - _ _ _ _ —�ET FOR CUSTOM TANKS CONTACT WIESER CONCRETE
1 �v� I � I
�
� - � U � - � I �Q , J
U
`t � � I r� � I d = M �
I � � g Z
1 2�" �---J-----�--- � 1 o Q
--�- -� �
REVIEWED BY � U
;,-, PUMP PAD REVIEW DATE � a
w
DRAWINGS SUBMITTED �
SIDE VIEW FOR APPROVAL
APPROVED BY: SHEET N0.
APPROVAL DATE: � �
oF
PRODUCTS NEEDED BY: / �
TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS
PAGE 4 OF 4
In-ground Gravity Management Plan
IMPORTANT:
The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to
requirements of SPS 382-384,Wisa 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,all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in
accordance with SPS 383.52(3),Wisc.Admin.Code.
Maximum Dispersal Area Operatinq Limits:
Design Flow= Y� gpd; BODS<_220 mgL''; TSS<_150 mgL-'; FOG<_30 mgL"'
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
age of system
, 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 extent af ponding in distribution cell prior to dosing
c dosing irregularities-if applicable(i.e.,pump re-cycling,float switch settings,etc.)
c electrical components-if applicable(i.e.,wiring,connections,switches,controls,timers,alarms,etc.)
o 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 Checklist MAINTAIN EVERY 3 YEARS(or when necessary)
o Septic and dose tank(s)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(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 maintenance reports shall be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc.Admin.Code. Report any compon f lure or malfunction to: � ��� '���
Nameofindividualorcompany: V�s� �'""1 �-'�'"'"�°l `�'C Phone: �/ d
Local government unit: W �6� Phone: �lS �'3� �-.D�
Local government unit address: �� � � 1 �ti ZIP S �7� �1�
Any defective part of this system shall be repaired,replaced,or removed pursuant to SPS 383.51(1),Wisa 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 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.
System Abandonment
If use of this POWTS is discontinued,it shall be abandoned in accordance with SPS 383.33,Wisc.Admin.Code.