2008/07/25 - SANITARY - SAN - Other

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SBD 6678 (R.08/83) (Plb 100a) (W-s Stats.S. 145.02) STATE OF WISCONSIN DILHR x Detach And Return Upper DIVISION OF SAFETY& BUILDINGS Portion Of This Form With BUREAU OF PLUMBING 201 E.WASHINGTON AVE. RM 141 Any Return Correspondence P.O. BOX 7969 MADISON,WI 53707 608-266-3815 DATE: PROJECT: PLAN ID.# DETACH HERE PROJECT NAME PLAN ID.# This is to acknowledge receipt of your plans and specifications for the above-indicated project. Preliminary review indicates the required fee is$- Fee Received is$ - 0 Plan accepted for review. ❑ Underpayment—Please submit additional fee. Plans will be held in abeyance. ElPlans being returned. E] Overpayment—Refund forthcoming. ❑ Additional information required. SEE BELOW. ❑ No fee has been remitted. Plans will be held in abeyance. I. Plan Submission ❑ Soil boring and percolation test data on 115 completed ❑ Additional information shall be submitted in duplicate unless by Certified Soil Tester.(1 copy) specifically noted. ❑ Petition For Modification signed by county,owner and ❑ Plans not clear,legible or permanent. notarized.T copy) ❑ All information submitted shall be signed,dated and sealed or ❑ Complete data relative to anticipated use of building. stamped in accord with Section ILHR 83.08 (2) (a) Wisconsin ❑ Deed restriction required.T copy) Administrative Code. ❑Affidavit enclosed. ❑ Condominium declaration.(1 copy) ❑ Plot plan showing location of land parcel (distance from nearest road intersection, etc.), lot size and all distances from IV. Holding Tanks private sewage system to buildings, lot lines, well, water- ❑ Holding tank profile showing vent,manhole,alarm, course, swimming pools, water service piping, all weather ser- and manufacturer if state approved.Complete vice road,etc. Show benchmark with permanent elevation. construction details if site constructed. ❑ Holding tank agreement signed by owner and local II. Pressure Distribution Systems (Mound or Inground Pressure) unit of government(sample enclosed). ❑ Application for Use of an Alternative System signed by owner ❑ Reason for installing holding tank.Statement from and notarized.(1 copy) county or soil boring and percolation test data on ❑ County onsite required.(1 copy) ❑ Design calculations. 115 completed by CST,showing that a soil absorption system ❑ Soil boring and percolation test data on 115 completed by cannot be installed on the land parcel. Certified Soil Tester.(1 copy) ❑ Affidavit for all-weather service road(enclosed). ❑ Cross section of system. ❑ Pipe lateral layout. ❑ Plan view of system. V. Dosing Information ❑ Verification to Exception Status Form by county.T copy) ❑ Calculations for total dynamic head and gallons pumped per cycle. III. Private Sewage Systems ❑ Size,length and depth of force main. ❑ Ground slope with 2' contours in entire area of soil absorption ❑ Detail and model of pump or automatic siphon,including system extending 25'minimum on all sides. size,pump curves,drawdown,and average flow rate(GPM). ❑ Location of area suitable for replacement system—provide soil ❑ Cross section of dosing tank showing pump(s)or siphon(s). data. ❑ Construction details of septic,holding or dose tank it site VI. Systems in Fill (Fill must be placed prior to plan submission.) constructed,or tank manufacturer if state approved. ❑ Total area filled(fill to extend 20'beyond edge ❑ Construction details and cross section of soil absorption of trench before side slopes begin.) system. ❑ Depth and type of fill. ❑ Copy of signed onsite report by county or district staff.