1983/10/06 - LAND USE - LUP - Dwelling/Principle Building - Single Family - 11098

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SD6678 (9/81) 1PIb 100a) STATE OF WISCONSIN DILHR ��t letabh And Return Upper DIVISION OF SAFETY& BUILDINGS 'ortion Of This Form With BUREAU OF PLUMBING 201 E.WASHINGTON AVE. RM 178 my Return Correspondence P.O. BOX 7969 MADISON,WI 53707 608-266-3815 DATE: PROJECT: PLAN ID. # DETACH HERE 30JECT NAME PLAN ID. # his is to acknowledge receipt of your plans and specifications for the above-indicated project. •eliminary review indicates the required fee is$ Fee Received is$ Underpayment—Please submit the additional fee. ❑ Overpayment— Refund forthcoming. Plan accepted for review. ❑ Plans being returned. ] No fee has been remitted. Plans submitted with no fees will be ❑ Additional information required. SEE BELOW. held in abeyance. Plan Submission ❑ Complete data relative to anticipated use of bldg. ❑ Additional information shall be submitted in duplicate un- ❑2 copies of PLB 60 enclosed. less specifically noted. ❑ Deed restriction required (1 copy). ❑ Plans not clear, legible or permanent. ❑ Condominium declaration. (1 copy) ❑ All information submitted shall be signed,dated and sealed or stamped in accord with Section H 63.08(2)(a)Wisconsin Administrative Code. ❑Affidavit enclosed. IV. Holding Tanks ❑ Profile of holding tank showing vent, manhole alarm and manufacturer if precast. Complete construction details if Pressurize Distribution Systems (Mound or In Ground Pressure) site constructed. ❑ Application for use of an alternative system signed by owner ❑ Holding tank agreement signed by owner and local unit of and notarized. (1 copy) government (sample enclosed). ❑ County onsite required (1 copy). ❑ Design calculations ❑ Reason for installing holding tank.Soil test or statement for pressurize distribution. ❑Soil boring & percolation from county (1 copy). test data. ❑ Plot plan showing location of holding tank with lateral dist- ❑ Cross section of system. ❑Pipe lateral layout. ances to any building, wells, water service piping, water ❑ Plan view of system. ❑Plot plan. course, lot lines, swimming pools, all weather service road, ❑ Verification of Exception Status Form by County. (1 copy) Etc. Provide benchmark with elevation reference point. I. Private Sewage Disposal Systems V. Lift Pump ❑ Ground slope with 2' contours in entire area of soil absorp- ❑ Calculations for total lift pump discharge, head and gallons tion system extending 25'on all sides. pumped per cycle. ❑ Elevation of permanent reference point (benchmark). ❑ Size, length &depth of force main. ❑ Location of area suitable for replacement system - provide ❑ Detail & model of pump or automatic siphons including soil data. size, pump curves,drawdown and average flow rate GPM. ❑ Plot plan showing lot size and all lateral distances from ❑ Cross section of lift pump tank showing pump(s)or sewage disposal system to buildings, lot lines, well, water siphon(s). course,swimming pools,water service piping, Etc. ❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precast. VI. Systems In Fill (Fill must be placed prior to plan submission) ❑ Construction detail and cross-section of soil absorption ❑ Total area filled (fill to extend 20' beyond edge of trench system. before side slope begin). ❑ Soil boring and percolation test on 115 completed by cer- ❑ Depth and type of fill. tified soil tester (1 Copy). ❑ Copy of onsite report by county or district staff.