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INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT .
<br /> APPLICATION
<br /> TO THE APPLICANT:
<br /> f. 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 act! onty A. new permit may be needed
<br /> it there Is a change in your building plans, system location. est Imated 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 TransferiRenewal F-orm (SBD 6399) to Le
<br /> submitted to the county prior fo installation;
<br /> 5- Private sewage systems must be properly maintained- The sept,c iankls; sl;ould be pumped by a licensed
<br /> pumper whenever necessary. usually every 2 to 3 years.
<br /> 6 If you have quer ions concerning your private sewage syst -ru ,r,ta t ocil code aum uistratcr or ,he
<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_l. Fill in number of bedrooms if building is a one or two family dwelling;
<br /> Ill_ 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 AbsorpLon system Information Provide, all information requested in 01-6
<br /> VI Tank information. Fi!l io the ^apaorty .)f every new andlor exist.I�g tank A rhe total gallons to be irsta!led
<br /> number of tanks and manufacturers came: Indicate. prefab or site constructed and tank material. Complete
<br /> for a//septle, lift'siphon chamber and holding tanks for this system. CtIeck experimental approval only if
<br /> tanks received experimental product approval from DILHR,
<br /> VII. Responsibility statement. Installing plumber is to fill in name. license (w ber 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 /> Vill, Soil test information_ Certified soil tester-s name. certification number rnidress_ and phone number
<br /> IX. County/Department Use Only,
<br /> X. Comment area for use by nxur+,y c' erziaeir Given wham apps ,atiun is (;approved.
<br /> Complete plants and specifics' r ,s c' i:idr:r t' r r - rc5mr; m-.rt he submitted to tnr -:o�ntr '. _
<br /> plans nus! include the follow rgg. A; ; f plan. drawn to sen- rn w;fh (! .ripleie dirensior, r-.alio,
<br /> holding tank(s) septic tank'q) nr other treatmemi;tanks; bu '" se n, r.. %ve.11- water mai-r.'rva'e-se
<br /> streams and iakIns, (]()sing h" pumping ciPanlbers. dist6bub m L��xes sa.I ahsorpfion systems. replacement
<br /> system a K-;s. a: e toes , w ' -_ sr r'oIl. B1 h ,i t ,!ovation •Inference rin,oc
<br /> C; rsmpilitn �4,ecifeations for pumps and controls. dose volumeelevation differences. friction loss; pump
<br /> performance curve; pump model and pump mar,ufadurer. Dj cross section. of the soil ab= rpfion system if
<br /> required by the county, F) soil test data on a 115 form.
<br /> GROUNDWATER SURCHARGE
<br /> Gn May 4. 1y84. J98e VvI,,f,JJSJlI4..I all.; w s Gnec +�io law Till .gislt . , ruOfe
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<br /> its worth protecting.
<br /> SBD-63981R.03 86)
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