HomeMy WebLinkAbout022-1053-20-020
i. SANITARY PERMIT APPLICATION
=Zah70-LHR COUNTY
In accord with ILHR 83.05, Wis. Adm. Code
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than
8% x 11 inches in size. ❑ Check if revision to previous application
--See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
% %,S T N,R E(or)W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
11. TYPE OF BUILDING: (Check one CITY NEAREST ROAD
❑ State Owned ❑ VILLAGE:
-
1:1 TOWN OF:
❑ Public ❑ 1 or 2 Fam. Dwelling--if of bedrooms - PARCEL Ax NUMBER(S)
111. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line 8 if applicable)
A) 1.0 New 2. ❑ Replacement 3.. ❑ Replacement of 4. ❑ Reconnection of 5. LJ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit # _ Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY ]2, ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Mindinch) ELEVATION
Feet Feet
VII. TANK CAPACITY Site
in alions Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank =04 =1:1
Lift Pum Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number:
Plumber's Address (Street, City, State, Zip Code):
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater a e Issued Issuing Agent Signature (No Stamps)
❑ Approved ❑ Owner Given Initial Surcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-8398 (formerly Plb-87) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
r
FORM - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP -
SECTION T N-.R W
ST. CROIX COUNTY, WISCONSIN
ADDRESS
SUBDIVISION LOT LOT SIZE_
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
Ct r 4ta ,r,1 3~ ".+A
C1_
-i., INDICATE NORTH ARROW
BENCHMARK:Elevation and description:
Alternate benchmark
Liquid Cap.
SEPTIC TANK:Manufaiiturer:
Final grade elev:
Rings used: Manhole cover elev:
- -4- n7 aV - ! -
F
2
PUMP CHAMBER
Manufacturer: Liquid Capacity: . .
Pump Model: If y Pump Size 1-
J I i ' Pump/Siphon Manu.f act
Elevation of inlet: Bottom of tank elevation
Pump on elev.: Pump off elev.: Gallons/cycle:
Alarm: Man.: Switch Type:l Location
Distance from nearest prop. line: Front_, Side, Rear,_Ft.
Distance from: Well Building
SOIL ABSORPTION SYSTEM
Bed: Trench: Seepage-Pit:
Width•~Length _ Number of Lines: Area Built
Exist. Grade Elev. Proposed Final Grade Elev._
Fill depth to top of pipe:
No. feet from nearest prop. line:Front , Side , Rear Ft.
No. feet from well: No. feet from building
HOLDING TANK'
Y
Manufacturer: Capacity:
No. of rings used: Elevation of bottom tank:
Elevation of inlet:
Side , Rear Ft.
No. feet from nearest prop. line': Front ,
No. feet from: Well , buildingnearest road
Alarm Manufacturer:
INSPECTOR:
DATE: PLUMBER ON JOB:
IN-GROUND PRESSURE SYSTEM'' 1 a F ~7
FOR
LOCATED IN THE ' v~'lq OF THE OF SECTION I9 T, N, R.. I$ .W,
TOWN OF 'cKa F ~ C t t~ 1C , S C. COIATY, WISCONSIN .
INDEX
PAGE I of 7 TITLE SKEET
PAGE 2 of 7 WORKSHEET
PAGE 3 of 7 PLOT PIAN
PAGE k of 7 PLAN VIEW-CROSS SECTION
PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT
PA GE b of 7 DOSE CHAMBER
PAGE 7 of 7 PUMP PERFORMANCE CURVE
PREPARED FOR
.RIA lm
PREPARED BY
U►B~I~~~E~t ~1~ ~ i_ T1,.~~T I Ivy
jJ~r
AND,
hots P~
P.O. BOX 74 423 K. MAIN 5T.
RIVER FALLS, V1t 54022
y` f~~~ 1&.1990
WORKSHEET Page Z, of
This trench type in-ground pressure system will serve a warehouse
and storage facility with 2 employees and 1 floor drain.
ABSORPTION AREA
Employees ---------2 at 20 gpd = 40 gpd
Floor drains -----1 at 50 gpd = 50, gpd
Total anticipated wastewater = 90 gpd
Class 1 perc rate 90 divided by 1.2 = 75 sq. ft.(Minimum area req'd)
2 trenches each 5' wide will be installed to provide 500 sq. ft. of
absorption area.
Trench #1 Head=4.5' 1/4" holes=l
.56 gpm/hole
8 holes X 1.56= 12.48 gpm
12.48 gpm = 49.23% of total X 90gpd= 44.31 gpd
49.23% of 500 sq.ft.(Total absorption area) = 246 sq.ft.-5= 49.2'
44.31 gpd - 246 = 0.18 gal/sq.ft/day
Trench #1 to be 5' wide by 49.2' long.
Trench #2 Head=2.5' 1/4" holes=1.17 gpm/hole
11 holes X 1.17= 12.87 gpm
12.87 gpm = 50.77% of total X 90 gpd= 45.69 gpd
50.77% of 500 sq.ft.(Total absorption area) = 254 sq.ft.- 5= 50.8'
45.69 gpd - 254 = 0.18 gal/sq.ft./day
Trench #2 to be 5' wide by 50.8' long.
SEPTIC TANK
Total anticipated wastewater = 90 gpd plus 750 = 840 gal. (Min. req'd.)
A 1000 gallon precast concrete septic tank will be installed.
Page of
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11. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers'at end of each lateral- ( Y required)
3. Install 4" observation pipes with approved caps- (_e~ required)
4. Septic tank to be \,~64to
gallon capacity manufactured by.
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5. wench Mark $M p ! LrL. I pp, q' O,A tpSS OF C, k-r-- m t~ 80k
5. Divert surface water around mound to prevent.pon ing at the uphill side-
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MODEL IJUMbRR: 1NGHES OR 6ALLOUS
SWITCH TUPE: 1-1 Ca.J9t~! y PUAP A1db M:AR*%- !rI'IKE TO. bfi:
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'T'OTAL `Qy1JiiMI: HSAO 9" .Fr~£T 1....•.,
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MODEL 97
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25'- a } _
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Z 15' W.96
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10'
~ ZI :35
2 k
5'
0 US 10 20 30 40 50 60 70
GALLONS -
240 10 '/s
LITERS 0 gp 160
FLOW PER MINUTE
TOTAL DYNAMIC HEADIFLOW PER MINUTE _
EFFLUENT AND DEWATERING
- CAPACITY - - 3'/,6
HEAD uNn SIMIN
FEET METERS GAL LTFiS 1` -
5 _1.52 56 212
10 3.05 46 174 I
15 4 57 35 133
20 6.10' 15 57
Lock Valve 23.75'
CONSULT FACTORY FOR SPECIAL APPLICATIONS
e Electrical alternators, for duplex systems, are available a Mercury float switches are available for controlling
and supplied with an alarm. single and three phase systems.
e Mechanical alternators, for duplex systems, are avail- a Double piggyback mercury float switches are available
able with or without alarm switches. for variable level long cycle controls.
SELECTION GUIDE
1. Integral float operated 2 pole mechanical switch, no external control required.
Standard All Models - Weight 33 lbs. - 1/2 HP 2. Single piggyback wide angle mercury float switch or double piggyback mercury
float switch. Refer to FM0477.
97 Series Control Selection 3. Mechanical alternator 10-0072 or 10-0075. ,
model Volts-Ph Mode, Amps + Simplex Duplex 4. See FM0712 for correct model of Electrical Alternator,' F-Pak"
M97 115 1 Auto 12.0 1 or 1 & 7 - 5. Mercury sensor float switch 10-0225 used as a control activator, specify duplex (3)
N97 115 1 Non 12.0 2 or 2 & 6 3 or 4 & 5 or (4) float system. unction box, torwatertight connectionorwired-in simplex or
097 230 1 Auto 6.0 1 or 1 & 7 - 6. Four (4) hole"J-Pak",j
2 pump operation, 10-0002.
Eg7 230 1 Non 6.0 2 or 2 & 6 3 or 4 & 5 7 Two (2) hole "J-Pak", for watertight connection or splice, 10-0003.
CAUTION
For information on additional Zoeller products refer to catalog on Combination All Installation of controls, Protection devices and wiring should be done by a
Starter, FM0514; Piggyback Mercury FloatSwitches, FM0477; Electrical Alternator, qualified licensed electrician. All electrical and safely codes should be followed
FM-0486; Mechanical Alternator, FM0495; Alarm Package, FM0513; and Sump/- I fety and Health Act nt National Electric Code (NEC) and the Occupational
Sewage Basins, FM0487.
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
3280 Old Millers Lane Manufacturers of .
! O ` / P.O. Box 16347 a Louisville, Kentucky 40216
OL ~L O~ (502) 778-2731 a FAX (502) 774-3624 Quaurr PUMPS ~HZr /g39