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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 Administrative Code will be applicable;
<br /> 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed
<br /> if 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 system,
<br /> 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
<br /> submitted to the county prior to installation,
<br /> 5. Private sewage systems must be properly maintained. The 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 your private sewage system, contact your local code administrator or 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 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 (i e. 10 unit apartment, 30 seat
<br /> restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling;
<br /> III. Purpose of application: Check only one in #1. Complete #2 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 if project
<br /> is in conjunction with University of Wisconsin,
<br /> V. Absorption system information: Provide all information requested in #1-6;
<br /> VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed,
<br /> number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete
<br /> for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if
<br /> tanks received experimental product approval from DILHR;
<br /> VII. Responsibility statement: Installing plumber is to fill in name, license number 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. Soil test information: Certified soil tester's name, certification number, address.. and phone number.
<br /> IX. County/Department Use Only, -
<br /> X Comment area for use by county or resaon g!ven whan application is disapproved.
<br /> Complete plans and specificat,ons nu' sma;ler thar E'_ '1 rich 'es n , 'oe submitted rc the _o,,, t, 'he
<br /> plans must include the foliow,ng A' plot pian, orawr ±e scare o' es
<br /> ;omplete dnner,sip m caticr. o'
<br /> hold ng tank(s), septic racks ,rhe k e.'. -r` ian4s _ d -c sew, , we''. wate mains' ,ste: > r
<br /> streams anC lakesdpc;er n,:,mpg-g rha—etc rrc!rib ltl0^ y'%y Pc cpi! ahc._,rp,tior cystemc, 'e�'aceme
<br /> SySfern areas. 3-,d she (i:n : 'i'. pr ;mid , . - r'Pv?':n erP'e' " _.
<br /> C) ecn fete specifications for -:pc and cnrtro s' dose volume elevafin, 'i.µ re r,c-s fr rrr
<br /> , ; •,
<br /> u
<br /> performance cv _r,,mf, c .,
<br /> mudel and' p , ,f -� ,'a _ ree..-. D; cress sec'r_ d the s::. at �-V te-r: c
<br /> requ-ec by 'he - c 'nty. F sci te;- Q. 72
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