1988/04/14 - SANITARY - SAN - Other

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INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT, APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years, 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable, 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system, 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 sea' restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling: III. Purpose of application Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair, IV. Type of systemcheck all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin. V. Absorption system information: Provide all information requested in #1-6; VI Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for a//septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form Fill in designer name if applicable: VII; Soil test information. Certified soil tester's name, certification number, address, and phone number-. IX. County/Department Use Only; Comment area for use by county or r esaon given when application is disapp,oved. 7,on-.,,Iefe pians and specificat-o-, ic,,f smal,e 're, F.. "I aches n _st �)e subrr fitted cc ir _:o�! •r ` ._ inclr7e the fuaoi.I.Ing. 4 ;:;a, s-.ale o, v .t- �ompi,• -�sio tar.k'^ teW a w = "di. -tbY :. _ _ i.. ?wr n e' m zte: oe Str P,3r'1�. ant' lakes Pei _u - :-equ On iVia"