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iPaFOPiVlA? ION & HASTRucTIONS FOR COMPLETING A SANIFARY PERMIT
<br /> APPLICATION
<br /> TO THE APPLICANT:
<br /> I. This sanitary permit is valid for two (2) years.
<br /> 2. Your sanitary permit may be 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 authority A new permit may be needed
<br /> f there .s a change in your budding plans_system Ocatior !mater' wastewater flew (number of be(',-
<br /> roomsetc.), depth of system. or type of system
<br /> 4. Changs in ownership or piurnbef requires a Sanitary Per w t `r arrster,Renewal Form ;SBD 6.399) to be
<br /> sribmitted to the county prior to installation.
<br /> 5 Private sewage systems must be p*operly maintained. Thr, s;ol tan. nl should be pumped by a licensed
<br /> pumper whenever ne:essa!y usual!; every ', lc 3 years.
<br /> 6 If yon; ' ave questa r; cork :ming =;or.' pr n;ale '-wagt I _ ^.Iart y_,rr ''0 3 rode ti i rlstratrr ,r the
<br /> State of Wisconsin, Bureau of Plumbing, 608-266-3815.
<br /> To be complete and accurate this sanitary permit application must Include.
<br /> I Property owner s name and mai!lrlg address- Provide the legal descript4la where the system is to be
<br /> installed.
<br /> II. Type of building or use servedIf public is checked, indicate type of use lie 10 unit apartment, 30 seat
<br /> restaurant, etc.; Fill in number of bedrooms If building is a one or two family dwelling,
<br /> In Purpose of application: Check only one in 41 Complete 4? It permit Is for tank replacement. reconnection or
<br /> repair,
<br /> IV Type of system check aR approln ate boxes <Jepur ding un system type- Check experimental only If project
<br /> is in conjunction with University of Wisconsin.
<br /> V Absorptir n system information. Provide all information requested w #1-6
<br /> VI Tank mfcrnat!a rill in the capac.ty f every n wan,;or x �Lmg tai n '�.st the rota) gallrrs to be yrs s led.
<br /> number of tanks and manufacturer's name Indicate ptet,h _rr site co r Acted and tank rlateriai Complete
<br /> lot a`r septic, lifl I_hambet anc oidiog (arks for tr,,s 5ysiee > erK experimental approval only ,f
<br /> tanks r(i experimental product approval from DILRR.
<br /> Vll. Respuns-bllity statement Installing p-umper is t; tit ,rnan e license ii1jml with appropr,ate pre`!x le g
<br /> MP, etc.), address and phone number. Plumber must sign application form Fill in designer name if
<br /> applicable.
<br /> VIII Soil test information: Cer+ifieC soli testers T,aine, ;cr0r(,afon number i dress. and phone %urrbe-
<br /> )X. County/Department Use Only,
<br /> X Comment area for use by 1 ouely .n -e,�aon give , whin app Icatlon Is cisapproved.
<br /> Conlplf to plan;' and specific io-s )o,t srnallrr r PT" - 1 ' inches must be submitted to the county Ti -
<br /> plans r u st ncludl. the following' 4J ,r 1; ?craw x sc m
<br /> with c p!efe . ^I �rs!on !rcatior ? •..
<br /> holder 1 ar'kls i.
<br /> seFt c tankr ) ^r otter 1 , .-.rk bu 1 mac, :cwo e'er
<br /> $1re a1}�ti Sind lakes do5mq Ur pomp,m) l:,,drober5 r1 yLrii)IIi nr irtitC$ L. � Ann Ol pie In _yStemn r-olal,r m-o
<br /> , ' c :wf it !11e u '.y i � � ) ;� .,.. p .L, PvahOn efo,('nr- pn',C1i
<br /> �7 �u ,e specrticatlons for pumps and controlsdose volume, elevation oifterences friction loss. pump
<br /> performance curve, pump model and pump D) cress suction of the soil absorption system if
<br /> required by the County: E) soil test data on a 115 form.
<br /> GROUNDWATER SURCHARGE
<br /> On May 4. 1984 '483 Wlsconsi , tiu uIo . ells i; ,I r ; ;Wore
<br /> __.,..
<br /> - GI oundtNi�iec --
<br /> .♦
<br /> .. u.oi. .)y y\>u. ..... 11111 tui. ,y,., ,
<br /> it worth protecting
<br /> SBD-6398 1R.03r86)
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