Laserfiche WebLink
SBD 6676(R.0843) (Plb 100a) (Wis Stats-S. 145.02) STATE OF WISCONSIN DILH R <br /> Detach And Return Upper DIVISION OF SAFETY&BUILDINGS <br /> OF <br /> Portion Of This Form With 201 E.WBUREAU ASHINGPLUMBING <br /> TON AVE. RM 141 <br /> Any Return Correspondence P.O.BOX 7969 <br /> MADISON,W1 53707 <br /> NS-2W3815 <br /> DATE: PROJECT: <br /> PLAN ID.# <br /> DETACH HERE <br /> PROJECT NAME "—A riz � PLAN ID. <br /> This is to acknowledge receipt of your plans and specifications for the above-indicated project. <br /> Preliminary review indicates the required fee is$� L-1 C) Fee Received is$ <br /> 'RI Plan accepted for review. El Underpayment—Please submit additional fee. Plans will be held in abeyance. <br /> t] Plans being returned. ❑ Overpayment—Refund forthcoming. <br /> El Additional information required. SEE BELOW. ❑ No fee has been remitted.Plans will be held in abeyance. <br /> I. Plan Submission ❑ Soil boring and percolation test data on 115 completed <br /> El Additional information shall be submitted in duplicate unless by Certified Soil Tester.(1 copy) <br /> specifically noted. ❑ Petition For Modification signed by county,owner and <br /> El Plans not clear,legible or permanent. notarized.If copy) <br /> El All information submitted shall be signed,dated and sealed or El Complete data relative to anticipated use of building. <br /> stamped in accord with Section ILHR 83.08 (2) (a) Wisconsin El Deed restriction required.(1 copy) <br /> Administrative Code. E]Affidavit enclosed. El condominium declaration.(1 copy) <br /> El Plot plan showing location of land parcel (distance from <br /> nearest road intersection, etc.), lot size and all distances from IV. Holding Tanks <br /> private sewage system to buildings, lot lines, well, water- ❑ Holding tank profile showing vent,manhole,alarm, <br /> course, swimming pools,water service piping,all weather ser- and manufacturer if state approved.Complete <br /> vice road,etc. Show benchmark with permanent elevation. construction details if site constructed. <br /> ❑ Holding tank agreement signed by owner and local <br /> 11. Pressure Distribution Systems (Mound or Inground Pressure) unit of government(sample enclosed). <br /> ❑ Application for Use of an Alternative System signed by owner Ll Reason for installing holding tank.Statement from <br /> and notarized.(I copy) county or soil boring and percolation test data on <br /> El County onsite required.(1 copy) 0 Design calculations. 115 completed by CST,showing that a soil absorption system <br /> El Soil boring and percolation test data on 115 completed by cannot be installed on the land parcel. <br /> Certified Soil Tester.If copy) El Affidavit for all-weather service road(enclosed). <br /> ❑ Cross section of system. El Pipe lateral layout- <br /> El Plan view of system. V. Dosing Information <br /> El Verification to Exception Status Form by county.(1 copy) ❑ Calculations for total dynamic head and gallons <br /> pumped per cycle. <br /> 111. Private Sewage Systems El Size,length and depth of force main. <br /> El Ground slope with 2' contours in entire area of soil absorption ❑ Detail and model of pump or automatic siphon,including <br /> system extending 25'minimum on all sides. size,pump curves,drawdown,and average flow rate(GPM). <br /> El Location of area suitable for replacement system—provide soil E] cross section of dosing tank showing pump(s)or siphon(s). <br /> data. <br /> El construction details of septic,holding or dose tank it site VI. Systems in Fill (Fill must be placed prior to plan submission.) <br /> constructed,or tank manufacturer if state approved- ❑ T6tal area filled(fill to extend 20'beyond edge <br /> El Construction details and cross section of soil absorption of trench before side slopes begin.) <br /> system. F] Depth and type of fill. <br /> El copy of signed onsite report by county or district staff. <br />