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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 be renewed before the expiration date, and at the time of renewal any new
<br /> criteria in the Wisconsin Adinlnistrative Code will be applicable-
<br /> 3. All revisions to this permitmustbe approved by the pernit issuing auth(,rlty A new permit may be needed
<br /> '.t there is a change in your building plans, system location, estimated wastewater flow (number of bed-
<br /> rooms. etc.). depth of system, or type of systern,
<br /> 1- Changes in ownership or plumber requires a Sanitary Permit Transfer/Pene.wal Form (SBD 6399) to be
<br /> submitted to the county prior to installation:
<br /> 5. Private sewage systems must be properly maintained rhe septic tank(s) should be pumped by a licensed -
<br /> pumper whenever necessary, usually every 2 to 3 years;
<br /> 6 If you have questions concerning you, p�.vate sewage systemcontact your !oral code administrator or the
<br /> State of Wisconsin. Bureau of Plumbing, 608-266-3615
<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 served1f public is checked, indicate type of use (i e. 10 unit apartment, 30 seat
<br /> restaurant, etc.). Pili in number of bedrooms if building is a one or two family dwelling;
<br /> III. Purpose of application. Check only one in ##1. Complete 42 if permit is for tank replacement, reconnection or
<br /> repair,
<br /> iV Type of system check all appropriate boxes depending on system type- Check experimental only it project
<br /> is in conjunction with University of Wisconsin.
<br /> V Absorption system information. Provide all information requested in 41-6,
<br /> VI- Tank informabor Pill in the capacity of every new andlor existing tank !!at the total gallon r to be installed.
<br /> number of tanks and manufacturers name. Indicate prefab or site constructed and tank mater a[ Complete
<br /> for a1%septic, hftlsiphon chamber and licldng tanMs fo, this: system C1`tct k experimental approval omy if
<br /> tanks received experimental product approval from DILRR,
<br /> VII Responsibility statement- Inst lLr,g plufnber is to fill nl name license number with appropriate prefix le-g-
<br /> Min, etc.), address and phone number. Plumber must sign application form Fill in designer name if
<br /> applicable:
<br /> VIII. Scil test information' Certified sal tester's name, cortificaiion number, address. and phone numbe, _
<br /> IX. County/Department Use Only,
<br /> X Comment area for use by cuunty resaun given ,n-hen app cation Is I:_nproved.
<br /> Cornpleli lar-s and speciticafion_; not hail 6'. t , !,,rhes mc,' b.� submitted to Thr. �untt. TP�E.
<br /> plans must ;-e1-de tin `ollt,w,ng' Pi plot pian, d,owli fr su r, ,-,' with c .mplete dirnp.ns,pols oration of
<br /> holden{ ran se,tic !ink-) . ^Thar o�'m�nt r ,w- ,..;i��.r^ sewer .._'"s. , re, main• vater;a_-vi-r.
<br /> soearrn, and lakes dosing or poml---o c namber, 01s11 dnriutl boxes. „r al—o,ofiwi syste ,s replacement
<br /> 'ras ?vatinn raf-cre nil c
<br /> - e point_
<br /> t �;or, :e ecihcatiur.s for pumps and controls. Jos» volurne, elevation ,inferences `rection loss: pump
<br /> per forrnance curve.; pomp model and.Aur p rianl f . iia. ui - , ss Lr�t{on of the _ ii4 abs irpti w system; ;f
<br /> required by the rounty. Fj Soil test data on a 115 town
<br /> GROUNDWATER SURCHARGE
<br /> On MAV 4. 1984. 1983, Wisconsin act 41C was l led la.v l !Is legislar- : s mora_
<br /> _ult C` eve. 2 4carS r _teau, a . .�r�_ _ T graoa� _ 7111 tyrou;.cwaYiit`i
<br /> o, ...,..
<br /> I tit
<br /> T
<br /> arrcly;cue
<br /> iCs worth protecting.
<br /> SBD-6398 111 01 86)
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