2008/07/28 - SANITARY - SAN - Other - 12456

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SBD 6678 (R.Q8/83) (Plb 100a) (Wis Sfats.S. 145.02) STATE OF WISCONSIN DILHR 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 808.266-3815 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$ ❑ Plan accepted for review. ❑ Underpayment—Please submit additional fee. Plans will be held in abeyance. ❑ Plans being returned. ❑ 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.(1 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.(1 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.(1 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 if site VI. Systems in Fill (Fill must be placed prior to plan submission.) constructed,or tank manufacturer if state approved. ❑ Tdtal 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.