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Home My WebLink AboutCROSS CONNECTION .P "1=;~ ~ ~m ofCcMnmerCe Safety & Buildings Division Bureau of Integrated Services APPLICATION FOR PLUMBING REVIEW AND CROSS CONNECTION ASSEMBLY REGISTRATION -Complete all pages- NOTE: Personal information you provide may be used for secondary purposes [Privacy law s. 15.04(1)(m), Stats.] GENERAL PLUMBING This form may be utilized for fax appointments. Indicate date plans will be in our office: July 13th Circle your choice of office: i.Next available appt in any office 2. Green Bay 3. Hayward 4. laCrosse 5. Madison 6. Shawano 7. Waukesha E Mall Scheduling PlanSchedule@c:ommerc:e.state.wl.us Toll free fax number (877) 840.9172 Transaction 10: 1. Complete for confirmed appointments.: ;;=;~ 20(~ 070C-P Previous Related Trans. 10 For next available appointment, plan status checks. see our website at http://wwW.commerce.stale.wi.uslSBISB- OIVReviewStatusSearch.hmtl. Assign~ Reviewer: Rich Wood Assigned Office: Oshkosh Review Start Date': 'Plans must be received in the office of the appointment no later than 2 workina days before the confinned aDoointment. 2. Project Information - Fill In all known information ProjectlSite Name Oshkosh West High School -- Interior Grease InteceptorReplacements Number & Street 375 N. Eagle St County Winnebago f23City 0 Village 0 Town of Oshkosh 3. Mailing Information After plans are reviewed, please: (check all that apply) o Call Customer 01,02, 03 (circle number)' l8I Mail plans to customer l8I1. 0 2, 0 3 (circle number)' .0 Requesting party will pick up. 'Refers to customer listed below 4. Complete the following customer information in the boxes below. Desi2ner Information (Customer 1) (person who stamped the plan) First Name Last Name Commerce Customer # Other, Please Specify (Customer 3) rltst Name Last Name Commerce Customer # Mark Huting Company Name Bassett Mechanical Address 1215 Hyland Avenue City Kaukauna (Area Code) Phone Number 232819 Company Name Address Stale Zip + 4 (9 digits) WI 54130 Fax Number City Stale Zip + 4 (9 digits) (Area Code) Phone Number Fax Number (920) 759-2500 920-759-2525 Email Address mark.huiting@bassettmechanical.com Have you submitted plans in the last year? ( ) Yes ( ) No Owmer Information (Customer 2) First Name Last Name Commerce Customer # Email Addres. Make checks payable to Dept of Commerce, Attach check here. Company Name Oshkosh Area School District Addres. Total amount due (From Page 3) $ $140.00 Minimum Fee $60.00 City State Zip +4 (9 digits) (Area Code) Phone Number Fax Number RE Ei eview code 7657 EmailAddres. THIS FORM IS VALID THROUGH January 2007 JUL 1 4 2006 S80-6154 (R. 0412006) 1 DEPARTMENT OF CO!v1MUNITY DEVELOPMENT .. SUBMIT ADDITIONAL PAGE 2 FOR EACH NON-IDENTICAL BUILDING OR TENANT SPACE BUILDING SPECIFIC INFORMATION 5. _ Chemical System (Not Eyewashes) Cross Connection Control Assemblies in Health Care Related FaCiiities to be reviewed _ Request to Register Cross Connection Control Assemblies in Non- Health Care Water Reuse System - _ Water Reuse System - stormwater for - ex rimental blackwater Interior use _ Water Reuse System - _ Water Reuse System - subSurface ra ater 1m ation 7. BUILDING SPECIFIC SANITARY: Select ONE of the followln six 0 Ions and enter the corres ondin diameter or Dralna e Fixture Units DFU and enter fee 1. Interior Sanitary Drain & Vent System and Exterior Sanitary Building Sewer 6. Item Description - Indicate items included with this submittal for this building Indicate the total number of interior fixtures, including roof drains and hose bibs being submitted for this bulldin. ~ Grease Interceptor _ Garage Catch Basin _ Oil Interceptor ___ Car Wash Interceptor _ Sanitary Dump Station 2. 0 Interior Sanitary Drain and Vent system only. 3. 0 Exterior Sanitary Building Sewer(s) only. 4. Interior Sanitary Drain and Vent system within an addition or remodeled bunding. 5. Multiple exterior Sanitary Building Sewers serving the single building, and the interior Sanitary Drain and Vent system 6. Interior Sanitary Drain and Vent System with multiple building drains exiting the building, no exterior sanitary building sewers 8. BUILDING SPECIFIC WATER: Select ONE of the followin six 0 tions and enter the corres 1. 0 Interior Water Distribution system and exterior Water Service 2. 0 Interior Water Distribution system, no exterior water service 3. 0 Exterior Water Service(s), no interior Water Distribution system 4. Interior Water Distribution system within an addition or remodeled building, no exterior Water Service 5. Multiple exterior Water Services serving the single building, and the interior Water Distribution system 6. JUL 1 4 2006 DEPARTMENT OF COMMUNITY DEVELOPMENT Fee Computations (doubled for installation without approval) (Check appropriate box and enter fee) Calcuiate the fees separately for each building. Number of Grease Interceptors... 6X $70.00, no additional fee if submitted with Sanita Drain & Vent Number of Garage Catch Basins..._x $70.00, no additional fee if submitted with Sanita Drain & Vent Number of Oillnterceptors..._x $70.00, no additional fee if submitted with Sanita Drain & Vent Number of Car Wash Interceptors..._x $70.00, no additional fee if submitted with Sanita Drain & Vent Number of Sanitary Dump Stations..._x $70.00, no additional fee if submitted with Sanita Drain & Vent Number of Chemical Systems..._x $70.00. no additional fee is submitted with Sanita Drain & Vent Number of Cross Connection Control Assemblies... _x$125 Number of Cross Connection Control Assemblies... _x$125 $120.00 minimum for each reuse system. (NOTE: Additional fees will be charged at $60/hr if review time exceeds 2 hours.) Diameter of sanitary building sewer(s) in inches._ x $40.00 Diameter of sanitary building sewer, in inches, required to serve the buildin . x $40 Diameter of sanitary building sewer(s) in inches._ x $25.00 DFU's new, added or relocated See fee table 1 on page 4 to convert DFU toa fee DFU's new, added or relocated See fee table 1 on page 4 to convert DFU to a fee DFU's new, added or relocated See fee table 1 on page 4 to convert DFU to a fee diameter or Gallons Per Minute GPM and enter fee Diameter of exterior water service in inches, or if serving a combination domestic and fire sprinkler system, diameter of interior water distribution immediately after the meter or at the buildi control valve in inches... x $40 Diameter of interior water distribution immediately after the meter or at the buildin control valve in inches x $40 Diameter of exterior water service in inches.. _x $25 GPM added or relocated See fee table 2 on page 4 to convert GPM to a fee GPM See fee table 2 on page 4 to convert GPM to a fee GPM seeree table 2 on page 4 to convert GPM to a fee Page Fee Subtotal _Number of Identical buildings X above Fee Subtotal Fee subtotal (carry to bottom of Page 3) 2 Required Fee 140.00 $140.00 1,3:. .r- )>c:... 0.0 0.0" @z en nl en 3 <D oc..>o en ....... en ::T01::T "z" o. g ~m::T - nl ~ ~-<D -<Den (J)r+ :::t:::c <D -. !2.::T (J) (') ::T o o ~~~ -0 co en :J _. InlCO -. r+ :J (') C <D <D ..., ..., :J <D .. en <D ~ o <D < o. ~ N c..> N ex> c..> ~ ~_"t. , -e. ~~c. ~, ,.... 1'~~ ~ -,J. 'O-~ ~ <n s~ -~ 1- -;t.. ~ ~, "'J;> ~, ..,. ~ \1--\ -:: - - ~ ~ V'\ l" ()"') ~~, ., ~ 1..""'",- ~~~ ~ w \1\ "R ~, -c:I ~ ~ -:.. ~-::t... <:> C. '?~ ~ \)l~ \1"~ o~~ <>- <:) ~<5' -.....~ ~ <""0 A (:, ~ '^ ." r- Il" ""0. m5 ...., m <a ~ "'." ::DO!!! Or- 0-% I OC80~{j) )..., !B1~~o"tl ~ m-~r-"T\S: , ~a5CD~O~ ~ iO~o~;o '\) og....m"~ t'\ ~m !gm ~ 0 ~:r~ m m ..... 0 ':., E~~E' E JUL 1 4 2006 DEPARTMENT OF COMMUNITY DEVELOPMENT ~ ~ 0\ 06/06/2006 15: 24 FAX 262 827 3~ _ BADGER-Wi> TRADING co. --.--- ~002/003., ^. Schier Interce~!ors Sizing Recommendations for Schier Grease Interceptors ... /J /) Date: ~ -6 ...a Sizing B9~ p~ Customer Name:.ID-~S e lr !VlB(!.,/1 Customer Location: Job Name:1!J~H- ~Ou.J We;;-f-1-I-:5, Job Location: t')GIlIc.~fI; LL/Z SINKS compartments Size Total Holding Capscity (Length lC Widtll x Depth 01 Single compartment) In Gallons x .75;; x = X.75:::; x_= x.75=X_'" x .75 = x .. " - DISHWASHERS Model , ' Gallons per Rae!< water Consumption Racks per Hour Gallons per Hour x .S (12 hr.) '" x .5 (12 hr,) = FOOD WASTE DISPOSER Model Horsepower SOUP KETTLE SIZe 40 6A-ttoJ1/ @ Th/2ep .qCJh#~t.tJlY' ~vp /::;ettte US//1/& 3o~ t? F"- /7fJ /)f-L-- OTHER t!J4-PM/-ty PeJ/2- CLe/}-.4/}/Y'tG' (rZ-6I/-h>'3) :30 RECOMMENDATION: D Gallons per Minute , j5lUqUid HOlding TOTAL ~Icw ~ste Uquld Holding Capacity G.P.M. in Gllllon9 c3~ Model '2A-:-rb - {)'6 3.1)" -- ~ Gresse Cap~='IY in LaS. 35 40 /~t:) NOTES: Schier Products Company represented by Badgenand Trading 2415 South 170th Street. New Berlin', Wisconsin 53151 . Phone: (262) 827-3177' Fax: (262) 827-3176 ill. )>C- 0.0 0.C" coZ en Ol en 3 (I) :;:~a? ""U co 00 r:J -. __ Ol co o .-+ :J (I) c: (I) :J co :: 00 (I) ~ o (I) < cr (I) (j) co Ol 000--1 (I) ..., -OlOl :aro:J (I) .. 00 ..., Ol 2~n I -. .-+~o o I :J ...,o~ I 0>.. (...) (") o 3 Ol ?- ~~ .L. -+ t:> t' ~ ~, T'J -\ <: ~;':A <rI-\ a t.:r , <J~,l C"> ~ _ o v \1" ~ "--\ ....0 - \J'~ ~ -Q6" ~~~ '\ \ \ f& ...-Q -:1>4 Q") I\) (...) I\) co (...) . <:.\.J ~ \) o <S'~ ~~ ~~~ ~~\ -~ 'T ~~ ~~ ~""i:. ~<T) \ ':1\ I i.~ : i~88~1~' ~ :m;1:~0"U \ mzl:!:-n~ ~ r.. "OG)c>>>OZ v O(')~Z(I)(I) ~ zoc>>o:z:>> \ ~ oo.m"'m , ~m !f6~ ~ ~ ~:z:~ _ m ~ o~ ~ ~ ~ c - -~ ~ --( - - - -( f=-G "$)"" -:. -:s:.. ..,. ~ 1'- feEl E JUl 1 4 2006 DEPARTMENT OF COMMUNITY DEVELOPMENT 06/06/2006 15:24 FAX 262 827 3176 l}iU)GERI..A.NDTlW>ING CO. I4l 003/00~ ' . ..t ::: Schier Interceptors . Sizing Recommendations for Schier G~~rCePlors .J . · j? _ Dale: 6- 6 -{)~ Sizing B~ €~ Customer Name: f3 AlJG e 7T M ~I, , Customer Location: K fkI it!, A-tI)/ 11- f WI Job Name:()~ffrtl5Jf Lt/e!G-r- /-I-~. Job Location: tfY511 kPZ;~ U/r:. SINKS / I Size Total Holding Capacity (Length x VVidth x D~pth or Single Compartmenl) in Gallons ~ 7~:;1&Y7.-~ [7-. ':37.;7' .x.75 = [)'7,&Bx-.L= ~~gB compamnems x.75;;; x = x.75::o X_'" x.75: X_"" DISHWASHERS Model Gallons per Ra~ . Water ConsumpUon Racks per Hour Gallons per Hour x .5 (12 hr.) = x .5 (12 hr.);;; FOOD WASTE DISPOSER Model HCI~power souP KETTLE SIZe OTHER. RECOMMENDATION: ~ Gallons per Minute o Liquid Holding TOTAL :;>. 7, gR L----- Modol J?&T& - ;:2420- ~c Flow Rate G.P.M. Uquid HoldIng CapacllY in Gallons Grease capacity in LBS. 3l? gt CIa NOTES: Schier Products Company represented:'by~dg8rland Trading 2415 South 170th Street. New Berlin', Wisconsin 53151 . Phone; (262) 827-3177. Fax; (262) 627-3176