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INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT
<br /> APPLICATION
<br /> TO THE APPLICANT:
<br /> 1 This sanitary permit is valid for two (2) years;
<br /> 2. Your sanitary permit may he renewed before the expiration date, and at the time of renewal any new
<br /> criteria in the Wisconsin Administrative Code will be applicable:
<br /> All revisions to this permit must be approved by the permit issuing authonty Anew permit may he needed
<br /> if there is a change in your building plans. system !ocatior. c-stimated wastewater flow (number of bed-
<br /> roomsetc.', depth of systemor type of system.
<br /> 4. Changes in ownership or plumber requires a Sanitary Perio,t Transfer Renewal Form (SBD 6399) to ba
<br /> submitted to the county prior to installation.
<br /> 5 Private sewage systems must be properly maintained. The septic tankls; should be pumped by a licensed
<br /> pumper whene,et necessary _,Sually every 2 'o 3 years,
<br /> you have qua rig s cont r g your private sewage systr�m centar r YOU: for ii code administrator or the
<br /> State of Wisconsin. Bureau of Plumbing. 608-2.66-3815.
<br /> To be complete and accurate this sanitary permit application must include.
<br /> I Property owners name and mailing address Provide the legal description where the system is to be
<br /> installed,
<br /> II. Type of building or use served: If public is checked. indicate type of use (ie. 10 unit apartment. 30 seat
<br /> restaurant, etc.) Fill in number of bedrooms if building is a one or two family dwelling:
<br /> Ili Purpose of application: Check only one in #1. Complete #2 if per is for tank replacement, reconnection or
<br /> repair,
<br /> ,V. Type of system- check aii appropriate boxes depending or system type. Check experimental only if project
<br /> IS in cor)unchon with University of Wisconsin:
<br /> V Absorption system information: Provide all information requested in frt.1-6
<br /> 11I Tank irdoimatic^ kl.'I in the capacity of every new andior existing tank, list the total gallons to be installed,
<br /> r,,int c-r of tanks ar;d manufacturer-s :carne Indicate prefaL cr site constructed and tank material Complete
<br /> for ail septic, hf rsiphon chamber and holding tanks for this system. C t-ck experimental approval only if
<br /> tanks received experimental product approval from DILHR.
<br /> /II. Resp -r si b lity stat--n:ent s allimg plumber is to fill in name, ;icense c!:mber with appropriate prefix (e.g
<br /> MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if
<br /> applicable.
<br /> VIII. Soii test information. Certified so;t tester's namecertification number, address. and phone number
<br /> IX. County/Department Use Only,
<br /> X. Comment area for use by county or res,9en giver when apphcal is disapproved
<br /> Comp ate plans .,d specificano ,.s n!4 i,rliailer r3-.S � ;,� hes r.,iL! be submitted to the (our.y. -Irw
<br /> plans must include the `n!Ic , rig, P.; IcIt p ar,, . av o m;tt r„ :;piste J n c:nsion r.anon o'
<br /> hofdirrn tark(.s; SeOir, tank ) cr nice ',ae rrient lauksl hu dirsewers- vreNs, water mains water service-
<br /> streams and takes dosing or purnpir i1 chamber. ois;ftortu n nr,xys sr a absorption sysrr.rn s, replacement
<br /> syster� a F,!. �3y r r,u sr _, i r, ,crrtai ^rbc«; r^ovation reference points;
<br /> Cl) complete specifications for pumps and controls. dose volume. elevation differences: friction loss: pump
<br /> performance curve; pump model and pump manufacfurer Dt cross secfion of the soil ab,o!nt!on system if
<br /> required by the county E; soil test data on a 115 form.
<br /> GROUNDWATER SURCHARGE
<br /> On May a, 1984. 1984 Wisconsin Ac+ 41U war signeo ;nrc law This iegi5 ateon. Is more
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<br /> 'ea:_ d - F- 3_�..;a y..
<br /> uv..c r t : Groundwaiar
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<br /> imeo ov vont c .•�iu !� - .`(
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<br /> its worth protecting
<br /> SBD 6398 in 03i86)
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