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SBD 6678 (9%81) (Plb 100a) <br /> _ STATE OF WISCONSIN DILHR <br /> Detach* And Return Upper _s r DIVISION OF SAFETY & BUILDINGS <br /> Portion Of This Form WithBUREAU OF PLUMBING <br /> r 201 E. WASHINGTON AVE. RM 178 <br /> Any Return Correspondence P.O. BOX 7969 <br /> MADISON,WI 53707 <br /> 608-266-3815 <br /> DATE: L PROJECT: <br /> (Scv, AA, �2 /7 <br /> PLAN ID. # 32 /1 a3�s <br /> DETACH HERE V <br /> PROJECT NAMEZ4 PLAN ID. # <br /> This is to acknowledge receipt of your plans nd specifications for the above-indicated project. ') <br /> Preliminary review indicates the required fee is$ "(J, Fee Received is$ <br /> ❑ Underpayment —Please submit the additional fee. ❑ Overpayment— Refund forthcoming. <br /> ❑ Plan accepted for review. ❑ Plans being returned. <br /> ❑ No fee has been remitted. Plans submitted with no fees will be Additional information required.SEE BSk-QY ((J <br /> held in abeyance. <br /> I. Plan Submission ❑ Complete data relative to anticipated use of bldg. <br /> ❑ Additional information shall be submitted in duplicate un- ❑2 copies of PLB 60 enclosed. <br /> less specifically noted. ❑ Deed restriction required (1 copy). <br /> ❑ Plans not clear, legible or permanent. ❑ Condominium declaration. (1 copy) <br /> ❑ All information submitted shall be signed,dated and sealed <br /> or stamped in accord with Section H 63.08(2)(a)Wisconsin <br /> Administrative Code. ❑Affidavit enclosed. IV. Holding Tanks <br /> ❑ Profile of holding tan; showing vent, manhole alarm and <br /> manufacturer if precast. Complete construction details if <br /> If. Pressurize Distribution Systems(Mound or In Ground Pressure) site constructed. <br /> ❑ Application for use of an alternative system signed by owner ❑ Holding tank agreement signed by owner and local unit of <br /> and notarized. (1 copy) government (sample enclosed). <br /> ❑ County onsite required (1 copy). ❑ Design calculations ❑ Reason for installing holding tank. Soil test or statement <br /> for pressurize distribution. ❑Soil boring & percolation from county (1 copy). <br /> test data. ❑ Plot plan showing location of holding tank with lateral dist- <br /> El Cross section of system. ❑Pipe lateral layout. ances to any building, wells, water service piping, water <br /> ❑ Plan view of system. ❑Plot plan. course, lot lines, swimming pools, all weather service road, <br /> ❑ Verification of Exception Status Form by County. (1 copy) Etc. Provide benchmark with elevation reference point. <br /> 111. Private Sewage Disposal Systems V. Lift Pump <br /> ❑ Ground slope with 2' contours in entire area of soil absorp- ❑ Calculations for total lift pump discharge,head and gallons <br /> tion system extending 25'on all sides. pumped per cycle. <br /> ❑ Elevation of permanent reference point (benchmark). ❑ Size, length &depth of force main. <br /> ❑ Location of area suitable for replacement system - provide El Detail & model of pump or automatic siphons includinc <br /> soil data. size, pump curves,drawdown and average flow rate GPM. <br /> ❑ Plot plan showing lot size and all lateral distances from ❑ Cross section of lift pump tank showing pump(s)or <br /> sewage disposal system to buildings, lot lines, well, water siphon(s). <br /> course,swimming pools,water service piping, Etc. <br /> ❑ Construction detail of septic, holding or lift pump tank if <br /> site constructed or tank manufacturer if precast. Vl. Systems In Fill (Fill must be placed prior to plan submission) <br /> ❑ Construction detail and cross-section of soil absorption ❑ Total area filled (fill to extend 20' beyond edge of trencl <br /> system. before side slope begin). <br /> ❑ Soil boring and percolation test on 115 completed by cer- ❑ Depth and type of fill. <br /> tified soil tester 0 Copy). ❑ Copy of onsite report by county or district staff. <br /> "k <br />